Hurricane Jill

Organizational psych 101

Back in college, my friends and I had a saying: it’s not what you do, it’s who you follow.  Meaning that evaluations of how well you did your job are relative, and the key to looking like a star is to follow after someone who screwed up royally.  And that if you have the bad luck to follow someone outstanding, it’s nearly impossible to look anything but mediocre.

The phenomenon isn’t obvious until you spend several years observing an organization with semesterly turnover of 30+ leadership positions, all of whom are people you know well and have worked with in numerous capacities.  But once you have, it’s hard to miss.   And frankly, I’ve never had an evaluation that wasn’t strongly influenced by where the person ahead of me set the bar.  Not that that’s all there is to it, but it’s a far larger component than people seem to realize.

That’s all for today.  I have reading to do.

Sticks and stones

Nobody died last night.  Nor did I grossly mismanage anyone.  Yet conference was still a bloodbath.

Sleep deprivation is never fun, but for me the biggest toll of call is on my self-control.  Post-call I’m much easier to push over the edge, emotionally.  In fact, I routinely curse at all the cars around me over the slightest annoyance when I’m driving home the next day.  I also take the opportunity to curse out anyone else who pissed me off during the preceding 30 hours.  It’s cathartic. Plus it keeps me awake.

So it would have been pretty hard to deal with even the usual level of verbal aggression this morning.  But today, for some reason, it was significantly worse than normal. I’ve been a lot of places now in my medical training, because of Katrina, away rotations and internship, and I actually haven’t seen anything quite like this since pharmacy school.

I’m also sensing some disturbing undercurrents among the residents and faculty.  The other day in clinic I inadvertently walked into a conversation between a couple of attendings about alternative career options for one of the junior residents.   At first I was alarmed that they were talking about me, because they changed the subject very quickly.  But I’d heard enough that over the next couple of days it became apparent to me who they were talking about, based on the particular strengths of that resident. And obviously regardless of the resident’s identity, it was an inappropriate subject to discuss in front of another trainee.  So it’s not like I can’t figure out what’s going on.  I just don’t want to know.

My two cents

I’m not an active part of this policy debate, but here’s my take on health care reform. Continue Reading My two cents…

Coming soon: bring your ativan to work day

Apparently I’m not TOO sleep-deprived at the moment, since I was up in time to go to work this morning, and I’m off today.

The hospital claims they will be fully implementing Cerner in a month or two.  Everything all at once, including physician order entry.  This should be interesting.   Continue Reading Coming soon: bring your ativan to work day…

Fair vs right

I get a sense from the residents here that they’d consider it unfair if the place I just interviewed at offered me a spot.  No one’s said anything overtly, but there’s the unspoken question hanging in the air, “why you? what makes you so special?”

And it certainly wouldn’t be fair.  Then again, “fair” presumes that the playing field is level.  But there’s nothing fair about whether or not we’re given an opportunity in life, there is only what we make of the opportunities we’re given, and what that says about us.  And I know I’d make the most of that opportunity, and that it wouldn’t be wasted on me.

There’s a whole crapload of “unfair” I’ve been dealt in my life, and wouldn’t it be great if I really could build that metaphorical skyscraper of a career that I talked about so many years ago, despite it all.

WTF

Yesterday one of the upper level residents said to me, in the middle of a conversation about all the things I’m doing wrong, “I know you’ve been sick this last week, but this is not Family Medicine.  You can’t just go home or take a day off when you’re sick.”

I replied, “I’m aware of that, and I haven’t asked to. ”

Actually, the thought never even crossed my mind.  I haven’t missed a single day, and in fact, I took q2 call during the worst of it.

So seriously, WTF?

Now, privately, I question the wisdom of coming in when I’m that ill, and caring for a bunch of patients who are already only hanging on by a thread.  But I also recognize that it’s the best option available for my patients in the larger scheme of staffing availability, patient safety and so forth, and so I do it.

The way I see it, it’s not a matter of my image in the eyes of my superiors, or of my education.  In fact, it’s not about me at all.  It’s a matter of patient risk vs patient benefit of a team member showing up with a communicable illness.  When you’re a student, the balance tips toward patient risk.  You are less necessary even than the nurses, and your presence risks infecting the whole team, as well as any patients you care for.

But as a resident, patient benefit outweighs the risk; you are necessary and not easily replaceable if absent.  And in a program where residents are already stretched pretty thin, there simply isn’t enough staff to cover.  No matter how sick you are, you are better than the alternative.

However, this is not how most people see it.  And since the decision of whether to come in or not is the same for me now as it would be for someone else in my current role, and for any future role I will have in medicine, there’s no point in trying to explain.  People are remarkably unsophisticated when it comes to logical thinking, or ethics of any kind.  But as they say, if you see an apparent contradiction, question your underlying assumptions first, because one of them is wrong.

Some thoughts

As you might expect, being a PGY-2 in all but name leaves very little time for blogging.  Also there may be some really good news on the horizon (at least, I hope so!), and I’m just superstitious enough not to want to jinx it by talking about it.  Irrational, I know, but there you have it.

My main impression so far is that neurosurgery here is harder than it needs to be.  It’s true that at this place, you have to know your medicine and general surgery cold, as well as neurosurgery, and that’s certainly challenging. But they round for half the day here, which leaves very little time for actually getting any work done.  I have mixed feelings on this subject, mostly because, while I recognize the need for oversight, it feels very haphazard and inefficient as a means of teaching about critical care, not to mention neurosurgery.  I don’t feel like I’m learning much, other than that everyone has a different way of doing the same thing, and that good clinical judgment is a thing totally separate from being conversant with the literature of the field.  There are many things done here that are no longer done elsewhere, and things done routinely elsewhere that earn me that “Are you f-ing crazy?” look here from staff and residents alike.  And something tells me that being taught anything by someone in my position would be counterproductive as far as my intermediate-term goals are concerned.  In other words, while my long-term goal is to become an excellent neurosurgeon, I can’t be excellent at it if no one will let me do it in the first place. Which requires a residency, and pissing people off is not the way to get one.

However, the pharmacists here are on top of their game, and would give their colleagues at Harborview a run for their money.  They don’t round with us, but some of the protocols they have in place are well ahead of trends in the field, and they pretty much get what they want.  But the pharmacy practice act in this state is clinically the strongest in the nation, so that’s not surprising.