Saturday, September 15, 2012


It started as big day in the lab: six cases. Actually, my partner and I were eventually able to split the load over two labs.

But I screwed up.

I took too long putting in a device - WAY too long.  Four hours too long.  Since it was the first case of the day, it backed everything up. People had to work very late - some even had to dip into overtime.

But  I was impressed that no one said a thing.  In fact, everyone that I worked with was incredibly supportive.  After it was over, one of my nurse practitioners even bought me a salad on her own dime before she laid into me with a ton of pending questions about outpatients and the new consults upstairs.


Because my colleagues know about schedules in medicine.  They know that some things we do can be incredibly challenging due to anatomic variables that aren't always there in the normal individual.  They know that sometimes we work on sick folks, young and old, who really have no other options - that a particular procedure might be their one best and only shot at getting better.  They know that many other times, the cases go faster.  They know that these things can happen.  So they remain professional and make a their calls home to say they'll be late.

Schedules, I'm finding, are getting more complicated in our consolidated new health care world.  So much so that administrators are turning to computers to help.  And who can blame them?  Different cases, different time allotments, different hospitals, different doctors, different equipment needs, different drive times between facilities, different days for clinic, different insurance, different staffing needs.  It's simply getting too complicated for any one person to keep it all straight in their head. 

But computers rely on logic.  Computers rely on criteria on which to make decisions - they must have an estimated procedure time to go with every procedure.  Computers don't incorporate variations in physician skill level, technique, or a person's individual anatomy into their scheduling algorithms. Computers don't know about a son's baseball game.   Computers don't factor in the frustrations of traffic.

I never like making that call home when I am running late.  I never like to hear the sighs, the disappointment, to learn what I'm missing.  But I have also learned that it is far worse not to make the call.  My family's schedule and psyche demands it.

But as the day's work is algorithmically sliced across increasingly geographically-dispersed larger and larger health care systems with schedules more and more compressed, I wonder if computers will ever be able to explain to our families why we keep running late.



Anonymous said...

I cannot believe that no one ever thought of this aspect of medicine before. The only ones that get out on time are the non-professionals.

Anonymous said...


You and your team do wonderful work. But I don't exactly know how to take this post... Everyone I know has had to work late to solve unexpected problems or to attend meetings or travel on business. This is a problem that is not unique to medicine. What am I missing here?

Anonymous said...

Dr. Wes-

How about the fact that you had 6 cases on the schedule for one day? In addition to inpatient consults? That doesn't sound reasonable. It might work if everything goes perfectly, but as we know in EP, it rarely works out that way.

Sounds like a good way to boost your RVU's, but do you think trying to squeeze that much into one day is fair to your patients?

I wouldn't want to be patient #6 that day.

DrWes said...

Anony 10:10 PM -

6 cases / 2 docs = 3 cases each - pretty typical day.

What docs can't predict is how many patients get sick and when - we do what we have to do to care for people when they're here. Sure there are outpatients scheduled, but inpts must be scheduled too. RVUs, frankly, have little to do with it, especially as we work to avoid leaving patients on the ward waiting for their necessary procedure(s).

Automation of schedules on the surface looks nice, but will never predict the emergency or tough cases and the additional time they require.

What is toughest, IMO, is the geographic reach of larger and larger systems. Logistics with scheduling multiple cases at multiple facilities in this case can be a nightmare - there's only so many hours in the day.

Anonymous said...

"What am I missing here?"

What you're missing is that the patients whose cases get delayed are being encouraged to fill out negative patient satisfaction forms, so that Dr. Wes is financially punished for staying late and doing a good job.