Friday, March 15, 2013

The Importance of Recess in our Era of Sequestration

You can see it in doctors' eyes now, especially after 5 pm.

The spring in the step that used to be there is fading; the excitement of discovery being replaced by routine.  Change and uncertainty bear down on the continual demands for perfection and quality. Independent entrepreneurial spirit is systematically quashed by clinical pathways, metrics and RVU productivity quotas that fail to represent the time it takes to smile, to do the extra something that makes the case a success, to hold a hand, to explain things.  Hiring freezes.  Three-month delays for appointments.  All occurring with the certainty that the best is yet to come: more cuts are coming.  Yes, we've been sequestered too.

Be we dare not speak of this things.  We must be positive, upbeat, a leader.  Change requires leaders.  If you're not the lead dog, the view never changes.

Yet even our doctor-leaders look tired.  They are leaders no longer.  Someone without a medical degree is "leading" now.  The business world is like that.  Oh, sure, there are the Chosen Ones, but in reality, they are the spokespersons for business and, unfortunately, business has become medicine's reality.  The proverbial bloom is off the rose.

So it is surprising that I say this, but doctors' need a break.  Nurses and technicians, too.   We need to stop and look around and take care of ourselves.  Trust me: no one else in the corporate cog of medicine has an interest in this right now.  After all, productivity will suffer.

Yet it needn't be much, but it must be something.  Something separate from medicine.  Something separate from the hospital or the clinic.  Something that breaks from the daily and opens the eyes again.  And it can come in the strangest places.

For me, it was jury duty.

Yesterday I had the luxury if turning off my pager for a day.  I rode a train.  I saw the sea of humanity that exited the train and hurried, eyes downward, to their work.  I got to hear the guy hawking newspapers and playing a saxophone on the street, to look up at the huge skyscrapers downtown, to stop for the traffic lights and to smell the acrid smell of diesel fuel as the trucks went by.  I had the uncertainty of direction and the pleasure of discovery.  I went through security, found the jury assembly room, rode a non-medical elevator, and took a number.  I read, I watched other people - lots of other people - and suddenly felt pretty good.  I sat and did nothing, then got called and sat again.  I was a doctor, so I got bounced early (another personal injury case) and received my $17.20 from the court bailiff.  I saw the fountains were already dyed green for St. Patricks Day this weekend, and I saw the homeless guy on the street hugging his dog wrapped in a blanket.


So tonight, after work, we're all taking a break on me.  It will be somewhere we like, somewhere non-medical, somewhere fun.  We need it.  The stress in my colleagues is palpable.

After all, I have to spend my $17.20 somewhere.



Marco said...

Wonderful post, Wes. Overlaid on top of your enormous responsibilities is a culture (our larger American culture) that worships compulsive busyness as a virtue. In actuality, we need breaks to regenerate our minds and souls. We are the only developed country without a law requiring mandatory vacation; even China mandates 2 weeks. On a more local scale, being surrounded by similarly stressed people doesn't help. So, we need to take care of ourselves and claim our "downtime" and build strong boundaries around it. Not always easy. I love to wander around cities like you just describe, which is why I travel.

Art Fougner MD said...


You still have a pager?

Gary M. Levin said...

Recess? how about a year off, or better yet...retirement..otherwise, a wise post..LMAO