healthy workplaces

Fighting Moral Decay in Residency

Residency – especially intern year – can be compared to the trenches of war. You are enlisted for a period of time, while you dutifully carry out the orders of superiors, and fight the enemy (disease) while you tend to the already wounded and dying. It removes you from your normal life and can send you into unknown territory, consuming the vast majority of waking hours (sometimes as high as 100-120 hours per week, which is the rarely discussed loophole within the rule of “[no more than] 80 hours per week averaged over a 4-week period”). It can be doubly isolating because the only people who really understand your experience are your compatriots – the co-interns and co-residents fighting in the trenches alongside you. Further, doctors in training, like our veterans, suffer from psychiatric illness and substance abuse issues, but this doesn’t garner much attention unless there is a string of suicides or high-profile articles on the subject. (Time Magazine also ran a story about it in September 2015.) (more…)

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The Checklist Itself Doesn’t Matter

Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence.…We connect the engine of a Ferrari, the brakes of a Porsche, the suspension of a BMW, the body of a Volvo. What we get, of course, is nothing close to a great car; we get a pile of very expensive junk.” – Chapter 8.

I just finished reading Atul Gawande’s The Checklist Manifesto, which was first published in 2009 and spent some well-deserved time on the New York Times Bestseller List. Written by an attending general surgeon at Brigham & Women’s Hospital in Boston, this book tells the admittedly “unsexy” story of how a simple tool such as a checklist can improve the quality and consistency of outcomes in a wide range of fields: aviation, building construction, venture capital, and (even) medicine. All of these fields are complex systems – involving many moving pieces and players, and an inherent unpredictability of conditions, materials, personnel, and complications. In addition, these arenas assume a certain level of skill and require a high standard of consistency and safety, but errors and complications still plague us. We have reached a point in many fields where the problem isn’t ignorance (we do understand a lot about the world around us) but rather ineptitude (we fail to apply the knowledge that we have consistently and correctly). A checklist can help us improve our “eptitude.”

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I can’t let my patients see

I almost broke down in the theater tonight.
I fought back tears as the main character tried to navigate a confusing, capricious world.
I fought back tears when his parents argued about how best to care for him.
I fought back tears as he bravely sought answers to tough questions.
I almost broke down in the theater tonight.

I started an elective in Palliative Care last week.
I remained supportive but stoic as my patients tried to navigate a confusing, capricious existence.
I remained supportive but stoic when their families worried how to best care for their loved ones.
I remained supportive but stoic as they bravely sought answers to tough questions.
I started an elective in Palliative Care last week.

I almost broke down in the theater tonight.
I can’t let my patients see.

It’s the only model I have learned.
This is how a doctor behaves.

Right?