I woke up early before my alarm clock by about an hour.  I'm a little more tired than usual.  I'm ready for work but don't have to leave just yet.  Really don't want to be at the hospital longer than I have to.

I was just thinking about the first times I saw surgeons ask for another surgeon to come in and help them, like an intraoperative consult.  Some examples include a laparoscopic case with terrible amounts of adhesions, and oncology cases where anatomy might be disorder by the cancer itself or previous scarring, disease has progressed since the last imaging and there's some delicate vessel work involved.

The other surgeon will just come in nearly right away and scrub in or be a new set of eyes for a while and leave.

It's ok to ask for that kind of help in medicine, and usually no one says anything.

But it's so hard to ask your own team for help with things you're going through outside of work, or to help you change things at work that would help you perform better. 

I wish there were someone I could just call in everyday and tell them about what's happening, and they'd help me. It would be someone who "matters" because no one would care otherwise.  People will keep doing what they do, but if some inspection committee comes around, they turn into completely different people and really put in a lot of effort to make sure things look perfect.  It takes a big name or big consequences for many people in medicine to want to help or change an aspect at work.

There are a few times my ideas regarding patient care were ignored, and then someone older with more experience will say the exact same thing and suddenly everyone strokes their beard and nods in approval. I think there's a lot of selective attention in medicine. 

Everyone in the hospital is obsessed about patient satisfaction, which is paramount, but there's no worker/resident satisfaction that seems to matter at all.  I hear residents from all specialties complain and they have a lot of good points, but the gears of the medicine machine keep turning in silence.  Don't feel, don't think, and you won't fall behind, is what the system seems to say.

I remember hearing about a surgical resident who switched specialties and then "no one knows where he went after that."   I remember an surgical resident  saying she wished a car would hit her.  I knew one who switched from one surgical specialty to another, came back as an attending, and then left the program after not even a year to go have more control over his life. 

I see all this stuff online about wellness and burn out and there are people who actually dedicate their lives to make the lives of doctors better, but it seems like there have still been ongoing suicides, addictions, and people leaving medicine.

I think big factors are really systems based. No amount of meditation time is going to magically fix a nursing shortage and no amounts of "So and So Hospital Worker Appreciation Week" are going to make those instruments sterilize faster or help us spend less time swallowed up by EMR.  Group outings aren't going to help an overwhelmed hospital discharge patients sooner and with better outcomes. 

Problems need to get really bad before action gets taken, in medicine and other fields. I just feel medicine really lags behind though.  I knew a surgeon who repeatedly was banned from having medical students or residents because he was extraordinarily mean to them. 

I wonder how many damaged people enter medicine and how many start out relatively normal and well-adjusted and then become monsters.

Everyone everywhere is wishing for medicine to become a better field, but I just see more suicides and surveys showing career dissatisfaction grow.  I wonder what it'll take for medicine to change. If anything, it's gotten a lot worse with managed care, time pressure, EMR, and all kinds of committees making it a lot more inefficient to take care of people, insurance companies, the costs of prescriptions, and the growing physical and psychological burdens of caring for more patients.

Sure wish I could do something, believe me. If medicine were a car or a house I'd be out there right now gutting all the bad parts and drilling and hammering everyday at 3am.

Medicine needs to invest more in its own people. You can't just drive 200K miles without ever changing your oil and expect everything in the engine to work flawlessly. You'd literally be insane. 

Anyway I can't be late for work.   Thank you for listening to my early morning rant. I promise I will respond to all of you caring souls.  Thank you for materializing out of nowhere and telling things like you care, that I matter, that I'm caring and bright.

Thank you.