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