How the Practice of Medicine is Like a Beach House
“I just want to clean off my desk before I go home. Otherwise, it will be there in the morning and start all over again,” a physician recently told me. “But it’s endless.”
This is how the practice of medicine is like a beach house in which physicians are not guests, but glorified house cleaners. Between the parade of patients, you are constantly trying to “sweep up” the sand of the ever-present Electronic Medical Record (EMR). The main reason you are there, patient care, is set to a silent drumbeat of trying to stay on top of things that pile up outside the exam rooms. Even if your day is running smoothly on your end, there are countless other unforeseeable issues that can throw off an otherwise well-timed day. Even one late patient, can make you late to all the rest. “And then you can get bad reviews from patients who were kept waiting,” another physician laments. In a 3-year study of the Annals of Family Medicine, family physicians spent 6 of their 11-hour days on E.M.R., at least an hour-and-a-half of that spent after clinic hours. According to another study in the Annals of Internal Medicine physicians spent nearly twice as much time doing administrative work as seeing their patients.
The word “frustration” doesn’t really do justice to this situation in which so many physicians of all specialties find themselves. Like a beach house, every day you sweep, but each day the sand is there again.
While these statistics are not new, the E.M.R. monster continues to erode how physicians feel toward their jobs and their overall sense of purpose. Furthermore, given the statistics, even the administrative goal of cleaning off one’s desk before you go home each day is next to impossible to achieve. The time suck of the E.M.R. combined with the pressure to see more patients in a day, pulls physicians farther and farther away from the patient relationship itself — often the most fulfilling part of a doctor’s life. Over time, the daily un-winnable race to get the administrative tasks under control also dishonors the physician’s highest values, include timeliness, excellence of service, professionalism and respect, for example.
The persistent inability to clean off the desk or being late to patient appointments throughout the day accumulates as a pack of “failures”. Primary relationships suffer accordingly. When you become disconnected from yourself, you cannot help but be disconnected from others as well. Indeed, the feeling of never being finished cannot be locked behind in an office. You carry it home with you in a little emotional backpack. So by the time your spouse asks, “How was your day?” you have nothing left to say, except “fine” or, “it was a regular day.” When my former spouse responded this way, I thought, “Really? Could you seriously have spent your whole day saving lives and sum it up with ‘fine’?” I thought he was just putting me at arm’s length, withholding something more meaningful about his day, because he thought I wouldn’t understand the life and death of it.
What I didn’t know then was that that half of his day was spent doing something completely un-glorious, un-heroic. Little did I understand that much of his day felt like sweeping a beach house of sand. By the end of the day, when he finally came home, the sand was still there. And for him, talking about it was useless. There was nothing to say about it. Why tell me something so mundane and something I couldn’t fix? No, your spouse — or your coach, for that matter — can’t fix it, but here’s the thing about communication: It’s about connecting. It’s about intimacy itself. Simply sharing the burdens of your day can lighten the pack of “failures” and frustrations you’ve been carrying, and bring you closer to those outside of work.
By letting your partner, friend or coach in on your frustrations, you might actually lighten your load. While the mess might still be there, it may be a little easier to bear.
In addition to communicating your frustrations, try this…
Excercise of the week:
Make two columns: a bucket for things that must be done 100%, because lives depend on it; and another one for those things that do not need to be done perfectly and/or right now. The “perfection” bucket should account for about 20% of your tasks. The other less-perfect-can-wait bucket should account for about 80% of your duties. Every time you feel the pressure of “this must be done now” and perfectly, stop and decide which column the task really belongs in.
But learning to tolerate messy might be the only way to find sanity and happiness. By allowing your beach house to have some sand, you might actually be able to enjoy it a little more. Your pack of daily frustrations might grow lighter as you learn to put tasks in the appropriate bucket.
Would you rather chase the impossible or be happy?