“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Tuesday, May 22, 2007

The less you do .... the less you do

“What seems to us as bitter trials are often blessings in disguise”
~Oscar Wilde

I have a particular interest in education, so my view may be different than others. I also believe in changing things by working within the system rather than against it. That is where most of my opinions are centered.

We had a faculty meeting the other week and we discussed a number of things in regards to expanding the practice. We discussed increasing faculty size to fill wholes, both for the department and residency. We discussed the increased opportunities at different hospitals. We discussed new guidelines from the hospital, the university, and the ACGME. In the end, we talked more about the residency and solutions to get around the restrictions placed by the ACGME, university, and hospital. This has become a problem for us as well as other residency programs both surgical and non-surgical. Many may think this is another discussion of how the 80 work week hurts residency yada yada yada, but it is not. We are in changing times and we all have to give a little. The problem is that we only see things from our own point of view and therefore, always feel that we are being given the "shaft" and the other person is getting more. People love to complain. No matter how perfect the situations is, people will find something to complain about. Why do we have to be so selfish?

As a member of a "faculty", I look at things through the perspective of providing good patient care, improving resident and medical student education, increasing the academic knowledge base, improving department "market share," and of course, making a living and caring for my family. Many times, these goals are at opposition to each other. The most common thing that is at opposition to everything else is resident and medical student education. From my perspective, this is not appreciated by many receiving the benefits of my (faculty's) labor.

In a discussion about how to fit the educational requirements of the ACGME into the weekly schedule without decreasing operative experience, a number of resident complaints came up. Most of the complaints were typical complaints; "so and so yelled at me"; "I have too much call"; "no one loves me" (ok that was not true). The most disturbing complaints came when discussing how we have addressed previous complaints only to find out that they don't want that solution either. OK, this was like dealing with my wife when she was 9 months pregnant. "Move the dresser here. No, to far. No, not high enough. You don't love me 'cause I am fat." etc.

I read through a number of blogs and forums to get more of an understanding of the thought process of both the resident and medical student. It astounds me how often I read about how there is so much needless paperwork, call, and busy work, the number of times that people complaint about not getting to operate and in the same breath stating that they don't want to stay later to do the operation. I am trying to get a handle on most of this via my own perspective. The questions I ask myself are: "How can I inspire someone to want to do something because it is in the best interest of the patient even if it may have a perceived educational benefit?" "How do we get newly graduated physicians to believe that those who are here to educate them are not here because residents and medical students allow them to do less work?”

I guess this is one of those random rants from frustration. I do realize that my particular view is not the norm for many throughout the academic community, but it is more common than people are lead to believe on forums or in conversations between residents. Something that is lost during residency is the perspective of the "whole". Residents can only see as far as the next day or week and how it will affect them. Their world revolves around them. They can't see passed that, because they will be gone. They may be graduating or to another service. They are always viewing things through the eyes of a "short-timer". They care about how it will ultimately affect them. Patient care, procedures performed, relationships between services, and relationships with the hospital, are not as much of a concern because for a majority of the residents will not return. Faculty sees things using long term vision. When we see patients and their family we are looking at a relationship that may last for years. Procedures that go badly may ultimately be your albatross. Bad relationships between services make caring for patient more difficult and ultimately become a political problem. With reimbursements decreasing, most practices are becoming more dependent on the hospital for support and fund; this is a relationship that has to be maintained. A department or service is thinking about the “whole” and how each individual “part” will fit. Not everyone will win every time. It becomes a give and take, so that the "whole" will be maintained.

I guess in the end we all are selfish. I wish there was someway we could just put aside the “us verses them mentality” and just work together. We (faculty) are not against you (residents). We are on the same team. I think we are fighting for the same purpose. "Can't we all just get along?"
“Whenever you're in conflict with someone, there is one factor that can make the difference between damaging your relationship and deepening it. That factor is attitude.”
~William James

1 comment:

Anonymous said...

Hello friend,
I enjoyed this entry because although your perspective is so very different from mine from a professional standpoint, our opinions on resident education are quite similar. I am in private practice in every sense of the word. I see a huge volume patients compared to national averages and have an equally large surgery load. I eat what I kill and when I take vacation, no money comes in for the week. I honestly do not have the time or the patience to participate in academics. I keep current through journals and CME. I understand and appreciate MDs such as yourself who have dedicated a good portion of their professional lives to the education of others.
But here's the deal when it comes to residency (in my opinion): Youth is wasted on the young. What I mean is that it is very difficult to understand or appreciate what is actually happening to you when you are the one going through the training process (I didn't). You will likely never again be as stimulated, educated, and served as you are as a resident or fellow. Those tasks that seem meaningless may someday help you get out of a jam. You truly never know. I can't tell you how many times I have successfully managed a difficult medical situation based solely on an experience I had during residency. Residents are not only educated, they are also repetitively exposed to situations and tasks which will give them the CONFIDENCE to perform and make good choices when the decisions are theirs alone. In my opinion, that is a necessary function of a training program - provide an environment in which the individual is exposed to and participates in as many medical situations as possible so that when they leave the program, they are able to make sound decisions and perform their duties competently in order to achieve the best possible outcome for the patient. It's not always about the knockout punch (big spine case). It's more often about the jab (paperwork, knowing how to treat the staff, communicating effectively with patients and families).
I played catcher as 4 new lives came into the world last night. My fatigue has made me ramble.
I think I'll go buy Linkin Park's new CD today.