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Doctors Are Tired. Patients Will Suffer. The System Knows It’s a Pandora’s Box.

Dana Corriel, MD ponders aloud whether we actually WANT TO identify the REAL issues in our healthcare system, rather than place blame, and find ACTUAL fixes, rather than apply band-aids.

This just in:

Just breaking all over the world, in “Duh-News” (from the creators of Captain Obvious Chronicles), is a study that doesn’t actually elucidate anything we wouldn’t have otherwise known.

Brace yourself for the finding of the study: that doctors who are tired are worse at doling out proper pain management for patients.

And while I’m extremely sad to be reading this headline (that tired doctors equal worse pain management for patients means my own future won’t be super bright, as I’m aging, too, & will inevitably face times of pain), it doesn’t surprise me one bit.

Does it surprise anyone out there that when humans are tired, they don’t perform at their best?

Quick reality check: doctors are human.

I’m going to channel Sidney Zion here (he’s the father or Libby Zion, referenced below), and use a quote from a New York Times op-ed piece that he wrote, after the unfortunate & untimely death of his daughter: “You don’t need kindergarten to know that a resident working a 36-hour shift is in no condition to make any kind of judgment call—forget about life-and-death.”

The bottom line here is this: doctors aren’t above human behavior.

Because, once again.. wait for it.. we are human.

And yes, when humans are tired, it’s reflected in the quality of their work.

This is, after all, the basis of New York’s Libby Zion Law, which aimed to decrease the work hours of medical residents in training.

For background purposes, Libby Zion was an 18-year old patient who died in 1984, under the care of what her father believed to be overworked physicians in training.

It was a sad case that led to necessary changes in the culture of medical training, which looks to overwork its residents in an almost sadistic effort to ‘break us’. It’s like some initiation ritual that’s been deemed as necessary to making us stronger human beings that are purportedly more resilient. Which would all be good and dandy except that the entity on the receiving end are other humans. Patients, to be exact.

Listen, I know first hand the various factors at play today, from the doctors’ side, which govern not only the way our current healthcare system runs, but also all that’s required of us to dole out care within this system to heal.

And it ain’t pretty.

Here’s the bottom line here: if we don’t put in an extra effort to keep our healers healthy, they won’t be able to properly heal all of us, when we occupy the patient seat.
Case in point. Full stop.

Here's the bottom line here: if we don’t put in an extra effort to keep our healers healthy, they won’t be able to properly heal all of us, when we occupy the patient seat. Case in point. Full stop. Click To Tweet

Here’s another thing that sticks out at me, as I consider the title of this article:

that our natural reaction, as we read the title, is emotion. Anger, to be exact.

It doesn’t end there, though. what worries me is that this emotion – the anger – is directed at none other than the physician.

Classic.

As physicians, we are, and always will be, the front face of healthcare interactions. Regardless of what actually takes place beneath the surface, and how much control the physician has in that interaction.

The buck always seems to stop with the doc (rather than with the healthcare establishment which is failing the physician, time and time again), and it’s because society’s perception of the role the doctor plays within the system has not yet caught up with the times.

The buck always stops with the doc (rather than at the healthcare establishment which is failing the physician, time and time again). Click To Tweet

The article continues, offering up the authors’ solution:
“Gileles-Hillel said that the research should prompt increased efforts to counter doctors’ tiredness and encourage the use of technology that helps physicians with their decision making and prompts them to consider painkillers in response to certain complaints.”

Let’s quickly dissect the nuances of their statement.

Instead of focusing on the big, bright, red flag here – hey! Our doctors are tired. Is this something new? What’s really causing it and let’s truly discuss it, instead of suggesting that mere “band-aids” get placed – we immediately come up with solutions that will actually (even ironically!) make the doctors even more burnt out and tired than they are.


via GIPHY

Yes, let’s add even more technology and clicks into the once-sacred patient-physician interaction! We need more of it. More impersonal clicks and ticks.

And yes, I’m writing that out sarcastically. If you could only see me stating it out loud, it would be less likely to be lost on you.

Sadly, what we’re witnessing here are small windows of opportunity that are quickly slamming shut.

Instead of seizing the moment, and further opening up the crack to take a really deep look in, our system naturally blames the victim, and closes the window back up.

It merely adds more and more “layers” of presumable protection (the “use of technology that ‘helps’ physicians with their decision making and prompts them to consider painkillers in response to certain complaints), for the sake of change.

Isn’t it scary, as an aside, that outsiders think we need artificial intelligence to suggest that patients in pain could need a pain killer (ala the statement “helps physicians with their decision making and prompts them to consider painkillers in response to certain complaints?”). What’s being suggested here is that when someone says, “I’m in pain,” I need a machine to translate this for me into an ‘actionable’ item.

Seriously? Like, I know 1 plus 1 equals two, and I honestly don’t think that this deduction is much more complicated than that.

Why are adding more layers of work, that could potentially make us even more tired?

Let’s hold discussions about removing them! Not about adding more in.

Let’s hold discussions bout allowing us to go back to the old days, where computers didn’t require us to check off 70 boxes before prescribing a single med. (Read Demetrio Aguilla III’s Medicine’s Great Resignation: Can History Show Us a Better Way Forward, where he shares that “it’s estimated that approximately 60% of a physician visit is spent on documentation. In other words, of the 6 minutes that I was allotted for the patient visit, in today’s milieu, I would expect to spend 3.6 minutes on documentation, and 2.4 minutes doing all the other stuff. ”

Let's hold discussions about allowing us to go back to the old days, where computers didn't require us to check off 70 boxes before prescribing a single med. Click To Tweet

Let’s hold discussions about our having to get on a 30-minute call to convince a non-physician insurance representative, on the other line of the phone, that our patient needs what our 30 years of schooling says they do.

Or even about our having to refer within invisible structures that have been built, within the systems of medicine, to promote the Survivor-style alliances of healthcare big business? (refer to Daniel Paull’s Want to Refer to a Different Hospital? Sorry, You Can’t!)

Let’s be realistic, folks.

No one in (and especially not those who benefit from) our current health system wants to truly take a deep dive into the cause of this “tiredness”.
Everyone is well aware that doing so may open up Pandora’s Box.

And so we slam it shut with quick and easy solutions. Words that mean nothing to outsiders, except to purport a simple stress-load decrease on the doctor. And then we come up with even more studies that continue to place blame.

The cycle continues.

And the healthcare corporate joysticks play on.

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