Thursday, September 11, 2014

The Big Flail

After you've written on a blog for a long time, you begin to ask yourself why.  Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually happens. You try to provide a voice to issues that are often unheard, then realize that voice is only occasionally appreciated but more often duly noted, then ignored.  This is the nature of internet and quite frankly, medicine now - it is a world of competing interests.  On one side you have the patients, doing a messy job of getting sick, and corporate health care systems - either government, private, for-profit or non-profit - doing their very best to make sure their illness is neat and tidy, easy to control, perfectly understood, and quantifiable.  To this end, each has their own agendas that must be served, be it another regulation, value-added improvement, or a profit motive to secure the bottom line. 

This idea came to me yesterday in clinic.  Increasingly, every microsecond of my day, my week, my weekend has now been efficiently parsed into tiny computerized scheduling chunks.  It doesn't matter where I work, because like The Cloud, location doesn't matter - schedulers and administrative handlers can reach me, be it by beeper, computer, Outlook email, EPIC email, desk phone or my personal iPhone. There are so many places to check for messages that when I don't respond, the person trying to reach me just moves up the chain of communication options.  Eventually there's no down time, no time to think, there are few places to go where there is quiet any longer. It's become life by a thousand interruptions - a Big Flail.

Increasingly, there's a push to do away with beepers and move telecommunications in medicine to my personal iPhone.  But I an resisting this because I need to set a boundary between work and my personal life - if for nothing else but self preservation.  We are told this is being done in the name of "security" and "non-secure beeper messages" but I think it's because people don't want to wait.  They need their answer now. I really wonder what the evidenced based data on beeper message hacking is in health care and if more patients were helped or hurt by beeper data breeches.  There's a better idea, they say: consolidate.  It's more "efficient."  I know, I'm such a Luddite. But to whom do I respond when that head administrator calls on my iPhone as I'm  examining a patient?  How to I separate a Twitter message from an ER message? Does the act of looking at my phone when I'm with a patient engender trust or an appearance of distraction?

It's hard to argue with "security" when someone creates a new medical policy.  We all want to be secure.  We all want to know that our most private and personal  medical information is protected from prying eyes.  But quite frankly (and this is very politically incorrect to say) real information security in medicine is a joke.  After all, people's lives are perfectly encoded on a computer now and eight different billers, coders, insurance company trolls or hospital marketers can delve into that database of information and find specifics about a patient or group of patients with simply the click of a button.  Phishing schemes make a mockery of our passwords.  Seriously, who are we fooling? Let's be honest: paper charts housed in a known location behind a locked door were MUCH more secure. 

Hurry up.  Click here, click there, "Excuse me," "Can I have a moment of your time?", "There's a the 7 am meeting tomorrow," "What was that Ms. Jones?", "Yes, I'll try to make it," "Did you try it unipolar?", "Yes, I'll check my inbasket,""You left your addendum open,""They're calling for the cardioversion,""Should we add him in?", "I have to take my board review course, can you take call?,"The ER's calling,""Can you check her pacer, too, when you see her?", "Did you sign the EKG?"

Doctors need some quiet, down time, some time to think, to pay attention. We need to create our own boundaries between our personal and professional lives that are respected.  We need to think we can get away, to regroup, have some quiet time for ourselves or with a patient, even for a moment.  And if that means that some of us want to separate work from home by the use of a beeper instead of an iPhone, so be it. 

Otherwise, our personal lives will become a Big Flail, too.



Anonymous said...

Making time for yourself is something every person should find useful, and I don't mean this in a go to the coffee shop, relax, or unwind kind of way.

You're trading short term for long term if you're not spending some time making yourself better in a meaningful way (health, education, relationships).

Charlie Munger (sidekick of Warren Buffett) gives an example of something everyone probably should do, but very few of us will.

Charlie, as a very young lawyer, was probably getting $20 an hour. He thought to himself, ‘Who’s my most valuable client?’ And he decided it was himself. So he decided to sell himself an hour each day. He did it early in the morning, working on these construction projects and real estate deals. Everybody should do this, be the client, and then work for other people, too, and sell yourself an hour a day.

I downgraded my phone to something that barely texts and makes voice calls. Life is better. Others were frustrated with me at first, but they got used to it. They became more patient, more autonomous, and nothing really bad happened. After all, just 15 years ago we all lived out of touch for extended periods of time.

Turn communication off for an hour a day, and invest in your own personal and professional development. The world will go on without you.

Anonymous said...

Can you imagine a day in the distant future where there is one massive EMR ruling all of medicine? Then imagine that this EMR is hacked and every patient who is allergic to PCN is given PCN. All scheduled surgeries for an amputation are changed to the other leg. The acute MI is sent home. Shifts are cancelled and employees sent home. Xarelto given to patients who are bleeding, etc. etc.
Centralized control of medicine is a disaster in the making.

Anonymous said...

"schedulers and administrative handlers can reach me, be it by beeper, computer, Outlook email, EPIC email, desk phone or my personal iPhone"

I'm sorry, but who gave out all the numbers and addresses to people who don't need them? Beeper and office phone answered by the front desk are more than adequate.

Christian Sinclair said...

Excellent post Dr. Wes. Keeping a separation between work and personal life is very important for many healthcare clinicians. I've always had a work phone and personal phone for just this reason. Yes you have to carry my phone around many times but often you can do without one or the other.

As far as the blogging feeling pointless sometimes, I would encourage you to keep writing. We need more physician writers. I've been down on blogging before but I've recently rekindled my fire.

Anonymous said...

Completely agree...

See also insightful...