Healing Assembly Line Medicine

[Music]

trained

exhausted burnt out as a young doctor

this is my life i signed up to work in a

hospital

but it feels more like a factory

in the hospital factory patients arrive

on the conveyor belt

i deal with their problem then move on

to the next

patients wait hours for 10 minutes

of my time i want to give more

but assembly line medicine doesn’t wait

at the same time my attention is divided

my waist is lined with three pagers a

belt of grenades

that can explode at any moment and the

assault of

pages phone calls and interruptions is

endless half my pages are non-urgent

but always seem to come at the worst

times

during key procedures or even family

meetings

hi this is dr tang mr singh in bed 12

i’m looking after him he had a bowel

movement

okay how did it look

like chocolate it looks like chocolate

so pretty normal i’m aware of the order

to monitor stools

okay thank you

pages and bowel movements are like a box

of chocolates

you never know what you’re gonna get

assembly-line medicine is a problem of

culture

the cognitive load and distraction on

providers

is out of control to escape the chaos

i found refuge in this tiny supply

closet

it’s my sanctuary free from the

hospitals blinding lights

beeping machines and constant

interruptions

to think in silence

although my work can be painful it’s

patients who suffer from distracted

doctors

who never seem to have enough time

assembly line medicine is a hidden

pandemic

in health care i believe

a culture of deep work is the cure

the term deep work was coined by

georgetown professor cal newport

and refers to focusing without

distraction

on cognitively demanding work in

healthcare deep work

is the thoughtful reflection we do to

reach those

eureka moments that advance patient care

on a rainy day last fall i met sarah

a young woman in her 20s who presented

to hospital with recurrent chest pain

this time an ultrasound revealed cardiac

tamponade

a collection of fluid that was crushing

her heart in the middle of the night we

admitted sarah to the icu and emergently

drained the fluid

at first we thought this was all a viral

infection but as i slowed

down and probed further

sarah described many unexplained

symptoms like joint pains and rashes

this prompted me to order specialized

blood work that ultimately diagnosed her

with lupus

a rare but treatable disease

complex patients like sarah fall through

the cracks

of the hospital factory rigid policies

like one issue per visit fail them

making deep work impossible and rare

diagnoses elusive

luckily most patients don’t need eureka

work

they need routine but meticulous care of

common problems

like diabetes and high blood pressure

for most patients a fast-paced

high-volume system is appropriate

but it still shouldn’t feel like an

assembly line

like the doctor is always reaching for

the door

to leave

assembly line medicine falls short

for both complex care and routine care

to heal this system we need a new

culture

of deep work in a deep

work culture patients like sarah

would be diverted off the assembly line

where we could change gears from

thinking fast

to thinking slow

in a deep work culture even if your

doctor only sees you

for 10 minutes that time would be sacred

their attention free from distraction

in a deep work culture doctors wouldn’t

hide in supply closets to think

i’d like to offer two suggestions for us

to get there

the first is to free providers from the

shallow work

which engulfs our time

in a typical week i spend hours

printing stacks of paper and hunting

for patient charts these plastic binders

scattered across the ward

at least i’m getting my 10 000 steps

every day

it’s no wonder that a landmark study

found that junior doctors spend only 11

percent of their time

in direct patient care in a 10-hour

workday we barely spend an

hour with our patients

although we can’t get rid of shallow

work completely

we can find ways to make it more

efficient

what about pre-printing the most common

forms

or using secure apps to instantly access

patient charts on our phones

entire companies have found success by

making our lives

just one step easier zoom

is now a household name because they

simplified video calling

into a single click

assembly line medicine needs this

mindset

of process improvement there is a gold

mine of

untapped ideas from people who live this

life

patients nurses doctors lab techs

countless others together we can

heal assembly line medicine and create

a deep work culture

the second solution is to triage

or prioritize interruptions using

technology

to help us get there in assembly line

medicine

providers are bombarded with non-urgent

messages

each interruption fractures our

attention

pulling us away from patient care

it’s like death by a thousand cuts

our outdated communication tools

pagers only add to the problem

pages are like lazy text messages

with just a phone number no name no

message

no emojis but you’re expected to drop

everything

and respond

for this reason some hospitals have

retired pagers

switching to smartphones with secure

text messaging

this is an improvement as it allows

doctors to triage

non-urgent messages but it doesn’t

address the

underlying problem which is a culture

of constant urgency if

i can’t tell whether my next phone call

is going to be a heart attack

or chocolate colored bowel movement

we have not solved the problem

we need to start prioritizing quality

over frequency of communication

we need a culture of deep work

it was my life dream to become a doctor

but this profession comes with

tremendous personal sacrifice

assembly line medicine is wearing down

the healthcare heroes of our coveted

pandemic

the system has started to expect

heroism from frontline workers to

survive

a powerful op-ed in the new york times

makes this point

imagine in a factory

if 30 more items were dropped onto the

assembly line

the entire process would fail

but at 30 percent more patience to the

hospital

and the work magically gets done

the nurses skip their lunch the doctors

stay late to finish

the system gets by filled by the

compassion

of individual heroes but these heroes

are

burning to keep others warm

assembly line medicine needs a new

culture

of deep work where patients

can get the time and attention they

deserve and providers

don’t dread going to work

covid has reminded us we’ll all become

patients one day

so assembly line medicine is a problem

that affects

everyone but this shared experience

is also what unites us and gives us

all a voice to affect change

to heal assembly line medicine we need a

movement

in health care a deep work

movement because the hospital

isn’t a factory and patients

our parents our families

our loved ones we are not

products

thank you

you