PRSonally Speaking

Friday, September 6, 2013

A Plastic Surgeon's Dilemma: Finding the Balance
by Anu Bajaj MD
Many of my physician friends shared an editorial from The New Yorker on Facebook recently – Why doesn’t medical care get better when doctors rest more?  ( )  Most of us remember that in 2004 residency programs started to limit the number of hours that a resident could work continuously in an effort to ensure that residents had a enough rest and presumably would be able to provide better care. Whether this change resulted in better-rested and well-read residents who could provide better care has been debated. 
In this article, the writer brought up two interesting issues – the increased frequency of handoffs and the sense of responsibility physicians may or may not have. I’m not a resident nor do I work in an academic training program. But I was trained in the era before work hours were limited. I learned that each patient was my patient, and that I was directly responsible for his or her care.  And I’m not sure that there are limitations on work hours in real life.
This is not a new topic to my blog.  As most of you know, I have struggled with trying to find balance between family, work, and personal time. I started thinking about these issues again because of a random comment by a friend. This weekend, I was supposed to be out of town but cancelled my trip at the last minute. This meant that I had a day off – an entire Friday to myself.
Unfortunately, one of my patients called the office in the morning – she had a high fever and most likely had an infection requiring surgery. As a physician, I feel that I am responsible for my patients and that I need to care for them. I had to cancel several of my planned activities that morning. One of my non-physician friends asked, “why are they calling you?  Isn’t the on-call physician supposed to take care of it?” 
Fundamentally, I knew this patient well; I knew her problem, and by taking care of it, she felt much better by the afternoon.  If she had had to go through a different surgeon who was covering for me, there is no doubt that the whole process would have taken longer.  But, how do I explain this sense of responsibility?
My husband, who works with high school kids, pointed out that this view may be partly generational.  We’ve all heard how younger people today are better at turning off work when they aren’t working, unlike the previous generations. He also pointed out that this sense of “continuity of care” is important in many professions. As a teacher, coach, and assistant principle, he couldn’t just decide to disappear in the middle of the school year.  For that reason, our planned weekend away was controversial -- he would have missed the first cross-country meet of the season.  Prior to canceling our trip, several parents had commented that he knew how “to bring the girls up” for a meet and that they really appreciated his coaching ability. 
As physicians, I think that we like to think that medicine is different because we’re taking care of patients. It’s not just physicians who do a better job when they know the patient; all of us do a better job when we know the person whom we are working with. Essentially, in all aspects of our lives, we deal with people and relationships – ultimately, how we treat these people and these relationships will determine how good and how successful we are at our chosen professions. My father used to tell me that a plastic surgeon is married to his breast reconstruction patients because they are your patients for life. To a certain extent, I believe that this is true for all patients. I made a commitment to care for my patients through better or worse.  In all aspects of our lives, if we lose our sense of responsibility the quality of care declines. How many of us have expressed frustration at automated telephone systems and not being able to have human contact with airlines, banks, credit cards, etc? 
So, I suppose that increased hand-offs in medicine and doctors who don’t know the patient personally will continue to decrease the quality of care that we, as patients, will receive. The increased number of hand-offs has removed any sense of personal responsibility for the care that his provided. But this change in medicine is the same change that is occurring in all facets of our world in an effort to improve efficiency and control costs. As consumers, if we decide that we don’t like these changes or believe that the quality of care has declined, we have to fight for the old ways and the old sense of responsibility and personal relationships in all aspects of our lives.