, 12 tweets, 3 min read Read on Twitter
Is the only way to do good medicine today to give up our humanity in the process?

Why must our patients lives depend on our ability to do impossible things?

We’ve reached a breaking point.

This piece by @danielleofri is fierce truth telling.
What if clinicians stopped doing free work?

No staying late after shifts.

No seeing more patients than can be seen in scheduled time.

No charting from home.

Clock in, clock out.

Patients would suffer, business would suffer, and we’d be shamed for our selfishness.
The entire model needs a redesign.

The staffing model for many organizations has shifted towards using clinicians employed by hospitals. We get salaries. We work set hours.

But the professional culture is one of deep ethical responsibility. We don’t walk away when times up.
I am scheduled for 8 hours shifts in the ER. I almost never work 8 hours. It’s always 9-10+ hours factoring in charting and signout.

Why does the work as budgeted not match the work that I do? Because there are always more patients to be seen, yelling ”help me!” So I do.
Because Electronic Health Records are deisgned to bill, not to make my job easier. They make the work longer, not more efficient.

The art of user experience & human centered design that dominate consumer tech are almost nowhere in medicine.
We don’t staff for redundancy. When a surge of sick people show up, we take care of them. We work harder. We carry that weight.

As clinicians, we often push ourselves without saying ‘wait a minute, this is dangerous.’ But if we ask for help, there usually isn’t any.
I teach speaking up for safety. For awhile, I thought this was the problem. If more people spoke up, things would change.

But then I learned the hard way that speaking up only works if someone is listening.

We need organizations committed to change.
The model of the Fearless Organization @WorkFearlessly from @AmyCEdmondson is fantastic.

I’ve never seen on in healthcare.

The business model in medicine incentivizes all the wrong things. @RosenthalHealth has written about this extensively.
The status quo is really bad. About 70% of Emergency Physicians are burned out. 40% of physicians overall are clinically depressed. We have a huge moral injury & suicide problem.

We want to do the right thing for patients, we can’t, and it’s breaking us.
We need a strong healthcare workforce & functioning healthcare organizations to take care of our communities.

Our industry is struggling. We need visionary, creative, collaborative leadership to address the deeply broken status quo, redesign what’s possible, and move forward.
An important part of that relies on clinicians to focus on what we can control. To acknowledge what we do have agency over. To acknowledge when we choose security & salary over autonomy. To acknowledge our complicity in this mess. There are limits - but we have tremendous power.
Our generation needs to get involved in organizating & investing in the future of our profession.

It’s much easier to complain than do the work.

Let’s do the work. Every little bit helps.
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