Efficiency v Empathy

I love my job.  I think I like my job more than anyone else I know.  That’s not to say it’s not difficult or stressful at times, but the rewards far outweigh the stresses. My job is intellectually stimulating, emotionally rewarding, and even spiritually healing.  I’m a pediatrician.

As a pediatrician, my world is both “high tech” and “high touch”.  The tech part isn’t always a lot of fun but seeing a little face light up when they see me makes my face light up.  Oh, it’s definitely high touch.

Surprisingly, for one who loves these personal interactions, I love to be efficient.  My brain works in terms of processes.  How can I do this better?  How can I prevent errors?  How can I make the workflow smoother?  How can I reduce wait times without patients feeling like cattle and staff feeling overworked?  How can I meet the demands of my insurance and government overlords?   How can I design processes to get consistent outcomes across the entire office?  (With five providers and seven nurses that’s not always easy.)  I thrive when I can improve a process.  It makes my insides happy and gives me an internal attaboy.

When I was a resident at Emory, Grady had a horribly inefficient pediatric emergency room.  Don’t get me wrong, we were great at snatching a child from the jaws of death but we didn’t get to do that very often.  The ER—now called the ED everywhere (which I cannot wrap my head around because isn’t ED short for erectile dysfunction?)—anyway, the ER at Grady, unfortunately, was mostly about asthma, ear infections, rashes, sore throats, and a host of other non-emergency conditions.  Most of the time, I hated the ER rotation with its all-night shifts of nothing but ambulatory problems.

One New Year’s Eve (maybe I should say New Year’s morning since it was 1:00am!) I saw a mom with five kids in tow. They all had ringworm. I dutifully filled out the charts and wrote their prescriptions for griseofulvin.  At the end of the encounter, I asked mom why she had brought 5 kids at midnight on New Year’s for ringworm.  Her exact words? “I knew there wouldn’t be a wait.”  Her logic was impeccable.

When I was a senior resident, however, a new attending took over the Grady ER.  Within weeks it was a different place.  She created a whole new triage category called “R-GO” which stood for routine-GO. This was meant for those quick easy to treat ambulatory illnesses.  She assigned a resident to just see R-GOs regardless of whatever else was going on in the ER.  She assigned two exams rooms and a nurse to assist the resident.  It was like a miracle overtook the place.  Wait times went down.  Patient and physician satisfaction went up.  I loved it.

One morning I was assigned to do R-GOs.  I told the nurse I wanted to see how many we could do in one hour.  She was all in.  Admittedly my documentation wasn’t nearly as thorough as modern requirements dictate but we managed to see 12 kiddos in one hour and averaged 8 per hour that shift.  I finished mentally exhausted.  Have you ever been to the point that you just don’t want to make another decision?  Just choose my food.  I don’t care.  The attending said to me that day, “Jeff, you are going to be enormously successful in private practice.” Praise was rare during residency.

Because of my love for efficiency and my need to run an office to my own high exacting standards, I had a morning recently that was very frustrating. Nothing seemed to go right and my “efficiency” was thwarted from all sides.

My second patient, a teenager, wasn’t just depressed, but full-blown suicidal.  I do enjoy psychiatric care but nothing will blow up your schedule like a depressed teenager.  By the time I had made arrangements for her immediate care to prevent her from harming herself, I had six patients waiting for me—one for 45 minutes.

My next one was a 13-year-old new patient with chronic encopresis.  For those of you not in medicine, this kid was crapping his pants routinely.  Encopresis usually starts as a psychological problem.  A kid, usually a boy, with a need to control something about his life will refuse to use the toilet to the point that his colon is swollen and loses feeling. They can even develop a “megacolon” that interferes with proper bowel function.  Encopresis is never easy to treat but this kid had been at it for many years!  These boys are usually 7-9 years old when mom brings them in—not 13!  Treatment requires a bowel cleanse and chronic management to restore proper function. This requires a lot of patience and family education.

My next one was 21 years old and in 10 grade!  The next one was a new 13-year-old with five psychiatric diagnoses. My next one was an Indian mother (a doctor no less) who was very angry that she had had to wait.  After a couple of “routine patients” (as if there ever were such a thing), I had a mom argue with me about vaccines.  It took all my strength and patience to be polite when she told me that I “didn’t understand what was in vaccines”.  Good Lord, I wanted to slap her.

It was a hard day and I was frustrated.  My head hurt and I did not want to take my mood home with me.  I turned to Jesus with my frustration.

“Jesus, what was this about? Could it have been any worse?  I felt like I was hanging on by my fingernails to some semblance of orderliness and efficiency.  Today was not my best work.”

“Yes it was.”

“Pardon?  Jesus, you thought that was good work?”

“Jeff, today you rescued a girl from suicide.  You gave a mother and her son a hope of restoration that he won’t be going to high school next year pooping his pants.  You encouraged, you held hands, you walked alongside.  Sometimes efficiency isn’t about seeing more patients but about following me as we rescue the hurting.  You are my son and I am well pleased.”

“Thank you, Jesus, for trusting me with the greatest job on earth.”



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