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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Wednesday, September 24, 2008

Power outage from Hurrican Ike

Now 12 days since Hurricane Ike and still no power to my part of the Houston area. So no blogs for a while and for a short while to come. I only have access to a friend's computer or the wi-fi at a mall. Maybe next week things will be up and running again. Hopefully, my three readers will be patient.

Tuesday, September 09, 2008

More news on the fall out from restricted house officer work hours

Every time I mention there may possibly be some problems with the work hours restriction regarding house officers, I receive a barrage ( OK, 1 or 2 comments) from folks who consider me to be a old jerk who just wants a return to the good old days and that I want nothing more than to deny house officers time with their families so to better achieve the nebulous work life balance.

Thanks to Kevin for alerting me to this news item. In part, it seems like some surgery residents have been caught working too much in their misdirected efforts to try and learn to be good surgeons. Shame on them.

To disabuse these rebellious surgeon in training from their anachronistic aversion to shift work for physicians, efforts should begin earlier, i.e. in medical school. Rules should be implemented to limit the hours of study allowed for medical students.

Saturday, September 06, 2008

work-life balance,shift worker physicians and paradigms lost

Sometime in the 1980s the term "work-life balance " ( which I will abbreviate as "wlb" to save key strokes) began to seep into the universe of conversational and literacy discourse. I suggest the term itself may be a bit of a self contradiction or at least a poorly constructed notion. Work for the great majority of human adults is part of life so would not "work-non-work balance" be more to the point.

And the point seems to be basically that there is said to be some appropriate distribution of the hours in a week or day so that the proper of amount of time is spent working and in the other various domains of existence, which would including family time,recreation,and you fill in the blank with religion or community service or duck hunting.WLB had become a buzz word particularly in the business world wherein it is widely believed that companies must make some highly visible effort to help their employee achieve this wlb or at least appear to do so.

It is a modern concept and a concept that makes sense only when folks achieve a certain degree of affluence. It would have made no sense to talk to our ancestors who worked the land from dawn to dusk and then collapsed in bed to talk about balance. Pretty much every thing was work. Similarly millions of people who eek out a barely adequate living in those parts of the world now call developing (formerly known a underdeveloped) are not too concerned with discussion about the best way to balance their lives. In the 1970s and before medical students and house officers did not lobby their trainers, teachers and exploiters for a better balance in the work and non work lives.I don't know why we didn't , maybe we just were not that evolved yet or maybe we thought we could not get away with it.

When I did consultation work for a large international corporation, I frequently did examinations for overseas travel and executive physicals for the top small percentage of the employees. One such person was tasked to consult with high level managers to work out ways in which those managers could make it to happen that their employee would achieve this wlb. This individual traveled around the world visiting various general managers and vice presidents and noted that most could be fairly described an "workaholics". He told several of them that they would never achieve the alleged goal of more wlb without the leaders serving a role models. Almost to a man (or woman), the reply was basically : Look if I slow down or work less, some sob will take my job." The wlb manager soon retired early and moved to a ranch in Montana ( I am not making this up ).

Government officials and politicians who get into some type of hot water such as accusations of wrong doing often decide to retire and give as reason " spend more time with my family".
Nothing like getting caught to convince one to balance their work and life.

For some, their work is their life even though their position is such that they could opt to fish more, be ushers at church or have regular meals with their spouses. For them the balance is heavily shifted to the work side. Consider the degree to which physicians in their training shift much of their lives to the studying and working for a prolonged period of time. Do they accumulate a great unmet need for other activities so that when they finally finish training they are ready to catch up and re balance their wlb ratio, in part by becoming shift workers? Maybe so. Or since the income rewards are getting less and less and the prestige of physician work is diminishing and the autonomy is getting harder and harder to even find and when the pride of being physician gets to some personally determined tipping point maybe it is more politically correct to say you need more time on the life side of work life balance than to say screw it.