Healthcare- heal thyself!

The other day, I as I scarfed a meal in 3 minutes flat – I thought to myself, why do I feel so guilty about eating? Doctors are never supposed to eat, pee or sleep. It is a sign of weakness. Some sauce dripped onto my shirt and stained like a scarlet letter. An object of scorn, an opportunity for a colleague to jab “hey what’d you get for me?”.

I few years back, I wore the red cape of an ER physician, sacrificing self before everything else. Now I need to keep steady glucose levels during a shift or I won’t function.  I also don’t bounce back from a night-shift like I used to. So I started napping before every overnight shift.

So instead of hiding my shame over this any longer:

“I would like to make a  public confession: I am human.”

Now if only our system would recognize that!

Try bringing up the topic of having formal “breaks” for these sort of basic human needs , you may get responses like :

A. “yeah, that would be nice <wistful sigh> ”

B. “are you trying to start a union or something?”

C. *laughter* “oh wait, you are serious?”

But the value of treating employees humanistically is not a new concept. Recently it
has regained the spotlight, with companies voluntarily raising minimum wages, offering longer maternity (and yes, even something called “paternity leave” that has been imported from Scandinavia I think). #whyIlovenetflixevenmorenowAnd then there’s google with their public meditation spaces. Google builds its employees resting pods, while we master the art of eating from a vending machine on the way back from the restroom.

Google “rest” pod, soon coming to residency?

 

a “healthy” dinner break?

We have already wised up to the risks of sleepy doctors but those reforms have not gone much beyond residents. We worry about dehydration if our patients urinate less than four times a day but we rarely do it twice a shift ourselves. The values I learned in training—that patients come before food—are good morals, but they are foolish medicine. It’s hard to treat others humanely when you don’t first do it for yourself.

The importance of a healthy workplace culture is starting to be recognized in health care. Sure, certain hospitals do have formal breaks for physicians (typically if there is a physician union).

 

program at Stanford has been giving “credits” to physicians for the time they put into work, committees and students and letting them redeem them for things like home-delivered meals, laundry service and even help with grant writing.   The pilot program has decreased turnover and burnout and may lead to more productivity. But the fact that this program makes headlines means that it’s more of an exception than a rule.

By dehumanizing ourselves, in our workplace, we are doing our patients a disservice and not giving them the best care they can receive.

How many of you show up to work with a runny nose? Cough? Who knows of someone with gastroenteritis who tried to have an IV placed in the ED so he or she could continue working? At some point our over-compensated sense of work ethic starts to override common sense in terms of what is best for the patients we care for.

“When is an overactive work ethic bad for patients?”

Lean Back, Not In.

Tough work environments are not unique to medicine.  Writing in Foreign Affairs, Rosa Brooks states that long hours and crisis atmosphere in the foreign policy arena are worn as badges that “very important work is being done by very important people.” But in reality it’s just a sign of poor management.  Good managers recognize that human beings function best when they work in humane and flexible conditions. To paraphrase Rosa:

“The 24/7 nature of the job is no excuse for workplace policies that crush people”

A system that enforces lack of humanity (like extra work responsibilities without extra time to do it) can reinforce anger and bitterness and ultimately lead to job dissatisfaction and burnout.

The culture of “I’m in important person doing important things” can also lead us to treat each other poorly. The cranky  behavior  is learned, taught and passed down, then reinforced by the lack of humanity that is hardwired into the structure of our profession (long work hours, no breaks, no “real” sick days).

Doctors may be great  advocates for patients, but most are not gifted in the art of taking care of ourselves professionally. Saying “no” is not a normal part of our lexicon (good mentors will teach you this once you are an attending).  Perhaps this is a byproduct of our deeply entrenched sense of ownership and responsibility we carry for our patients.  But the academic setting seems to exploit this already pathologically over-productive personality. It’s as if the years of delayed gratification, fiscal sacrifice and stunted personal lives that are prerequisite to this noble profession have branded us into submission- where we accept tough work environments as a part of the job.

The time has come for us to heal this broken system.  Let’s be leaders in doing what’s best for patients- let’s do what’s best for the workforce that cares for them!

David Kessler

David Kessler

Director of Clinical Simulation and Pediatric Emergency Ultrasound at Columbia University Medical Center
David is also the research director for INSPIRE (International Network for Pediatric Simulation-Based Pediatric Innovation, Research, and Education). Outside of work, he enjoys spending time with his family, tae-kwon-do, saxophone, and musical theater.
David Kessler

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David Kessler

David Kessler

David is also the research director for INSPIRE (International Network for Pediatric Simulation-Based Pediatric Innovation, Research, and Education). Outside of work, he enjoys spending time with his family, tae-kwon-do, saxophone, and musical theater.