• Rosalind Kaplan, MD

How to Make a Doctor's Head Explode

By Rosalind Kaplan, MD

Last post, I was talking about playing the many roles I'd chosen in work and life. This weekend, I experienced playing an extra role I hadn't chosen and didn't want. I was a little more than halfway through the second of two holiday weekend twelve-hour shifts at urgent care when the medical assistant I was working with fell ill and had to go home.

Without any warning, I got a call from an administrator telling me that they'd tried to find coverage for her, but there was nobody available.

"Do you feel comfortable just running the site yourself for the rest of the day, or do we have to shut down the site?," she asked. Hardly a question, as we had a number of patients in the midst of care or waiting for care, so just closing up shop wasn't an option, as far as I could see. I told her we'd try to manage, since we were already doing so. I assumed she would ask the receptionist, who also is our radiology technician, to try to help out, and that she'd provide some information as to how to do some of the nursing tasks, like collecting and processing lab specimens and handling the end-of-shift tasks like counting meds and locking up the office. She had no such plans. She was about to hang up when I pushed her on what I was to do if I needed information or help. She told me I could call her if I needed anything, and that she'd 'let the receptionist know.'

The next few hours were hellish. The receptionist was not 'cross-trained', as many of the receptionist/radiology techs are, to do clinical tasks other than take X-rays, and was unfamiliar with the site. My student stepped up and tried to do the things she could, but she is still early in the clinical learning process. Which left me to take vital signs, enter medications and allergies and other data into the computer, collect and process blood, urine and other specimens, run point of care tests, clean wounds, administer vaccines and medications, and clean the exam rooms between patients, as well as perform my usual job of diagnosing and treating injuries and illness. I called the administrator once, when I couldn't find the right tube for a lab test. She didn't answer her phone.

I'm not going to say that I learned how important it is to have a good nurse or medical assistant. I already knew that. I knew I was taking on a lot when I 'agreed' to be the medical assistant as well as the doctor.

In fact, I'm not sure I learned anything from this experience. But I certainly was reminded of something I learned at other health system jobs. Doctors, particularly female doctors, are frequently asked to do what is almost impossible: to give more than 100% of their energy and resourcefulness to the patients they care for and the institutions they work for. Administrators know that we have a commitment to our patients, and that we will do whatever we can to provide what the patients need. They seize on that professionalism and take advantage of it, without regard to the physician's well-being. In doing that, they also lose sight of what is best for patients.

I limped through the rest of the day, calling nurses at other sites to ask questions and barking orders at my student and the receptionist, who did the best they could to assist me. When it was time to go, I had to call someone to ask where the keys to the medication room, which of course is locked, should be placed, and what the code to the alarm was. I went home hungry, angry, exhausted, a stress migraine beginning as I neared my house.

I was telling a friend about this unfortunate experience and she said, "why didn't you just say no?" I reiterated that the patients were already signed in and I couldn't turn them away. But here's the other piece: I truly wanted to be helpful. And in my usual female MD way, I also wanted to be agreeable. But I miscalculated, in thinking that other people might want to be helpful and agreeable, too. I'd forgotten what I'd learned at previous jobs.

Why didn't the administrator come in herself to try to help with the extra work? Or at least take the time and care to give me guidance or assign someone at another site to give me guidance on the things I don't know how to do? I didn't ask for that specifically at the time because I didn't think of it until later. Planning for staffing emergencies is not my job-- it is the job of the administrators. They should have had a plan.

Here's a question, the million-dollar question. If I were a male physician, would the administrator have done the same thing? Would she have even asked him to run the site without a nurse or MA? I very much doubt it. I suspect she would have been there herself in a shot.

Oh, and here is a crazy question. Why didn't anyone think to say two simple words: "THANK YOU"? A very basic courtesy to say that it was noted and appreciated that I went way above and beyond what I was hired to do.

My next-day email to the powers that be said that I would never agree to do such a thing again as it could have compromised patient care (I didn't let it, but all kinds of things can happen in an acute care setting, and a full team is essential), and that it compromised my own well-being. I wrote that I now feel quite demoralized by the experience.

I feel much better having put that out there. My headache has gone away. Now we'll see what they do about it.

I guess maybe I did learn something after all: say something before your head explodes.

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