The doctor will show compassion after he’s finished charting

I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest.

But this note stood out. In it, the administrator was reminding the medical staff that their job was tolerance, compassion and understanding. I’m not surprised by this. I’m aware that some administrators make ’rounds’ in patient areas and assess how things are going. (Concerns about HIPAA seem irrelevant, as I mentioned in a recent post.)

It seems, in a kind of ironic inversion, that the business side of medicine has tasked itself with telling the medical side how to be nicer doctors, better doctors, caring doctors. I’m not surprised; but I suspect it isn’t due to any collective epiphany about medical professionalism. Ultimately it’s really less about patient satisfaction, that Golden Egg that drives almost everything in medicine now.

But the irony runs deeper. While the CEO can hold forth on lofty, but important themes like understanding and tolerance, while various administrators can stroll through the ICU or various units shaking hands and making nice, physicians are doing something else. Lots of something else.

In the emergency departments where I work, physicians scurry out to see patients then run back to chart. And chart. And chart. And in many instances to sift through the endless possibilities of ICD-10 codes (I recently saw ‘2nd degree burn due to water skis catching on fire.’). Sometimes we are expected to code in more detail. Discharging a patient is, itself, often a complex process filled with orders, searches, clicks, signatures and locating the right printer.

I recently worked at a site with a shiny new nationally known EMR. ‘Please call the hospitalist,’ says I to the secretary. ‘Alright. Will you enter the consult order in the computer so I can document it?’ I’ve been handed faxes to fill out myself and of course, nothing gets done until it’s ‘put in’ the computer. Another rant for another day, as I digress.

The physicians rarely look up from their keyboards to chat, except when running off to see the patients who inconveniently stand between them and their real job of data entry, billing and coding. All done real time. If you don’t do it, by the way, you’ll get e-mails or texts the next day about your unsigned orders. ‘The coding department needs these right away.’

There was a time of collegiality. There was a time when we discussed cases and our feelings and our sorrow and our passion. That was when medicine was about people. Remember them? The upright primates on whom we practice medicine? Now? Now it’s about numbers and billing, metrics and tracking, satisfaction scores and rewards…and punishment.

Little wonder the CEO can round, or hold forth on the intangibles that lured many of us to love medicine in the first place. Physicians aren’t physicians anymore, not since we handed the reigns over to administrators so that we could ‘focus on the practice of medicine.’ And not since billing became so complex in order to justify every pen stroke, every bandaid, every pillow fluff. And not since the growth of administration, which has itself dramatically increased costs just as it has in universities across the country.

I want us to be tolerant and caring, compassionate and kind. But it’s hard to do when your entire job is less about humans and more about business. It’s hard to do when the volume of patients explodes thanks to unforeseen consequences of the ACA, the endless beatdown of EMTALA and the unending medicalization of everyday life. It’s nearly impossible when you’re tracked like a Caribou for every action and every key-stroke. It’s hard to do when there are no rests, no pauses, no coda in the great dance of emergency, or any other, type of care.

I often work in small, slower places. I do it in part because I can sit and talk. I can breath. I can think. Heck, I do it because I can act like a CEO.

Medicine is great. I love my work. But that’s the thing. I love my work. My real work. Meeting the sick and injured, figuring out what’s wrong, sifting through truths and untruths, danger and anxiety, solving problems.

I don’t love the slavery of modern medicine, which will be the same whether it is run by corporations or government. (So don’t kid yourself that nationalized care will solve this problem.) Governments and corporations are virtually interchangeable anyway.

Perhaps worst of all, I don’t like seeing my colleagues, young or old, as the joy escapes from them shift by shift, only to be replaced with exhaustion and bitterness. Or fear of some unknown repercussion from some faceless manager who leaves takes an hour lunch every day and leaves at five.

Maybe CEOs need to be lectured on how to have compassion and understanding towards their physicians and nurses. I think I’ll start rounding in their offices.

And writing my own memos…

6 thoughts on “The doctor will show compassion after he’s finished charting

  1. Dr. Ed:
    Always enjoy your articles and how you can interject humor in each story. I agree that CEO’s need to “walk in the trenches” every now and then to understand what others are dealing with and to “be seen” by their clients and workers. There was an old Joe South song years ago called, “Walk a Mile in My Shoes.” Maybe we should request it on our local radio station.

  2. I had to resort to satirical song writing in my head to channel the negativity and patient demands that I was receiving at triage ….yet I remained professional and with a smile. : )

    My edited version after saturday night. Needs to be sung with a guitar and country music accent.

    Just another night in the ED.

    Momma says fever but hasn’t given ibu,
    Baby’s crying, and I don’t know what to do,
    Inside I wanna yell,
    Gotta calm down and consult Dr. Bell,

    Chief complaint of wheezing and SOB,
    Continue to smoke and now I have CP,
    We’re 20 down and it’s midnight….
    EMS just brought in a facial lac post drunken fight.

    It’s just another night in the ED.
    My bladder’s full, but I can’t break to go pee .
    We sacrifice to care for you.
    Welcome to the ED cuz that’s what we do.

    Hx of cannibus, benzo, and meth use.
    Oh I forgot–add alcohol abuse.
    Texting while pain is “10/10”
    Can only take “dilaudid with phenergan”

    Been to 4 different ER’s for dental pain….
    Gotta keep trying because there’s Norcoes to gain.
    Seekers and cussers in the ED,
    Service with a smile because of Press Ganey

    It’s just another night in the ED.
    2 hours to go –Thankfully!!!
    We sacrifice to care for you.
    Welcome to the ED cuz that’s what we do.

    ED nurse
    KN-

    • KN, I think perhaps this deserves its own post. Is it alright if I do? If not, I understand. If so, would you like e-mail comments? Well done indeed. Thank you.

  3. Thanks Dr Leap for a well written familiar story.
    I lasted 3 years as a nurse and had to get out or I was going to have a nervous breakdown. One of many similar themed issues involved me being repeatedly reprimanded for not checking, charting, and filing (daily) the freezer temperature in the employee lounge. We also were assigned badges that could track us at all times even in the bathroom. During my last days at the hospital I had 5 patients who could not feed themselves and I had no staff to help them. I ended up rotating patients and meals (i.e. I helped Patient A with breakfast while patients B,C,D & E went without breakfast and then I helped Patient B with lunch while patients C,D,E & A went without lunch and so on). After 2 days I realized I was never going to eat nor were any of the patients. I had to get out of the most wired patient centered magnet champion hospital system or suffer eternal despair.

    • ‘I had to get out of the most wired patient centered magnet champion hospital system or suffer eternal despair.’ That, Stefanie, is a powerful statement. I’m glad you escaped. Thank you for sharing your story.

      Sincerely,

      Edwin

  4. For you Dr. Leap and ALL who read these very WISE MD sites.. Continue to do your absolute best . BECAUSE IT IS ABSOLUTELY GOOD ENOUGH in this System we work in., in 2016. Love and Light !!!

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