Schedules

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.

Why?

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.

-Wes