Wednesday, October 06, 2010

My Professional Goals

"Keep 'em alive 'til eight-oh-five."

As a resident in medicine, that was our mantra. (We turned over our patients to the next on-call residents at morning report each day at seven AM). "Keeeping 'em alive" meant you were a capable resident. To not acheive this goal was a sign of weakness amongst our peers - a tongue-in-cheek way of ascerting your clinical acumen between peers - and it was the prevailing zeitgeist for training at the time.

And in some ways, it's not a bad goal to aspire to as a doctor.

Each year, we're all asked to decide on next year's professional goals that we'd like to achieve in the upcoming year. "They must be measurable," they say.

At first, I must say I flinched at this idea. My normally cynical and paranoid self immediately intuited where this was going - "won't be long before they tie my pay to whether I meet my pre-determined goals by next year."

But it might be valuable to consider one's goals in medicine. It helps us focus on what's important and what we'd like to achieve. Lots of tiny goals achieved by larger system goals possible.

But what goals might need to be considered when seeing patients and caring for the sick?

Is it to do more and see more people in less time, thereby helping more people?

Maybe.

Is it to grow your procedural volume?

Maybe.

Is it to arrive in clinic on time?

Maybe.

Or is it to enroll more research patients than ever before?

Maybe.

Or is it to stop and listen, hold more hands, and slow down a bit more?

Maybe.

Or to get home before 7PM each night?

Maybe.

Or make every meeting on time?

Maybe.

Or learn a new procedure?

Maybe.

What is clear is that many of these goals serve different masters. Each goal is critical to the master served.

But what stuck me with this exercise is that the family master and the patient master never ask for these goals to be articulated. Workplace goals are. As such, workplace goals will always get bigger over the years and have the potential to to supercede family- and patient-related goals.

My personal goal is to never let that happen.

-Wes

8 comments:

Health Train Express said...

Maybe ??

Jay said...

Wes,

I'm at a similar point in my career and too have found myself getting philosophical about career and personal priorities.

I've come to the conclusion that there is really only one career priority that can't be violated: Every patient I "touch" gets high quality care.

That unassailable priority comes up against another unassailable priority, which is to be a great husband and father.

When things get crazy, I can see less patients, get help, or do less non-patient care work. What I cannot do, however, is give my patients or my family less of me than they deserve.

It frustrates me to see these values compromised in colleagues. We're doing ourselves and others no favors when we start making compromises an effort to increase productivity or stature.

It's tough to get such a simple concept into words, but I hope you get the idea.

Thanks,

Jay

DrWes said...

Health Train Express:

Depends on your goals, right? Want more people seen? Spend less time with them.

Want more time with patients to improve "quality/pt satisfaction scores," compromise productivity.

Yeah, maybe.

kai worrell said...

Dr. Wes,

would love if you viewed this short film featuring a cardiologist and ICD patient engaging directly in the design process of a new technology concept

http://www.worrell.com/newmagazine/articles/2010/design-we-can-all-live-with

Thanks! Kai Worrell

DrWes said...

Jay-

Nicely said.

Stop smoking help said...

How does the verse go, "to whom much has been given, much will be required". Choices have to be made, and sadly, they're never easy. You sacrifice so much and yet, more sacrifice is asked. I don't doubt that you'll know what to do when the times do come and those decisions must be made.

As someone who has idiopathic cardiomyopathy, I appreciate what the cardiologists bring to the table and I certainly enjoy your blog.

So after you make those big decisions in life, make the small one to keep blogging!

jimbino said...

How about a vow to publish your fee schedule?

Or quit working for an organization that pretends to serve the patient but hides the fee schedule?

Jay said...

Jimbino,

You should know that I am as much in the dark about my fee schedule as you are. The economics of health care delivery are made deliberately opaque to serve the interests of those in health care driven by primarily economic motives (i.e. generally not the doctors).

We are contractually bound to accept these fee schedules. There is no realistic way to do speciality care outside of the system. I applaud the efforts of the limited primary care doctors that have gone it alone on a fee for service basis. When your practice mission involves doing expensive procedures within hospitals, you pretty much have to play the game.

If you feel your doctor is using you to make himself rich, challenge him on this. If you don't like what you hear, find another doctor.

Jay