feedback

"Trust no one," my senior resident continually reminded us.  I have had a great two weeks at a Veterans Hospital, which is a little slower paced if also weirdly dysfunctional (nurses ignore orders, tests don't get performed, tests are not sent, tests are not run, orders are lost despite being in the computers, and everything needs to be followed up on three times).

I liked the setup because my team had its own room with a window - a large improvement on sanity.  We are encouraged to give and get feedback, and even to get feedback on giving feedback.  It has been helpful after floating around in a confusing fog through most of graduate school.

My senior resident gave me feedback today.  She thought I had kicked butt during the rotation (yay!) but had mostly words of advice: "Focus your energies on the 20% of people whom you can invest a little energy and help a lot."  She traced out a sigmoidal (s-shaped) curve with her hands, indicating the steep portion for the energy investment versus patient prognosis.  "Most people are either not going to be affected regardless of how much energy you put in," she said, indicating the bottom, flat part of the curve,  "or will do well regardless," she said, gesturing at the top flat portion of the curve.  "Otherwise, you'll burn out."  She paused.  "It is important to pace yourself to stay sane."

I've enjoyed our working relationship very much. She is very funny and cares a lot about patient safety.  She thanked me for inspiring her too.  "I remember being like you - all energetic and wanting to change the system.  Now I'm just tired and burnt out," she told me.  "Self-feedback: be more positive!"

We had talked about what kinds of changes would be needed in electronic medical records to really streamline the flow of healthcare.  Physicians are extremely highly educated clerks, at least at the intern level.  We had discussed possible ways to make this better where technology helped rather than hindered physician workflow.  Could we have automated documentation, decision assistance, or a more streamlined way of updating ourselves on the patient's past medical history?  Could we ask the computer a question in natural language and get a natural language answer about what previously happened?  Is it possible to centralize patient medical records and make them more accessible?

"Thank you," the senior resident said, "for giving me hope that things can get better."  At the moment, we spend a lot of time on clerical work and very little time on patient care or even diagnosis and creation of a treatment time.  Much of this struggle comes down to cumbersome electronic health care records.  But the reality is... we can do so much better than this.