¶ Embracing the ER vs. Clinic Lifestyle
When we are talking about the way that we work . Part of the reason that we work the way that we work is because we enjoy that setting . I enjoy being there for deliveries . I enjoy doing emergency surgeries . I enjoy kind of the unknown like okay , I don't know what the heck is coming through the door .
It can be very scary for people , a really big source of stress for people . They're like I don't like running to the danger . I'm okay preventing the danger , but I don't want to run to it .
Here's some concerns that I think some folks don't think about . If you embrace this type of lifestyle , there's always the question of continuity of care . Because you're not seeing folks in a clinic fashion , because you're seeing folks in acute care fashion , you're taking care of emergencies .
I took care of this emergency and , for the most part , I may not see you again or because it's shift work . I may not be on the next day .
Right .
Right . So the care of the patient some people think could be , could be a little bit disjointed
¶ Addressing Continuity of Care Concerns
. I hear that a lot . I'd like to answer that . So one of the ways that I get around it is I don't take like shifts for just like one day and then I'm gone for like two weeks or something like that . I do like seven days in a row and then you know , I take a break .
And the reason I do that is just for that reason , which is the continuity of care thing . I'd like to be really involved in someone's care over several days , formulate a plan and then , right when you get to the point where it's like you know what , it's time to take a break .
I let the patients know , I let the patient's family know that I'm going off shift . But we have this sign out process where I talk to my partners they'll take care of you over the next couple of days , several days and we talk about what's the best way to take care of you and stuff .
But yeah , I think that there's a concern that , ok , I have surgeon A on Monday , surgeon B on Tuesday , surgeon C on Wednesday . Are they all on the same page ? That could be a concern .
Is that a concern with OB hospitalists now , I think now patients are kind of sort of used to not necessarily seeing their doctor or the same doctor .
Come on , you know , I think patients are getting used to like maybe starting the delivery or starting the labor process with a doctor and then potentially ended ending up with another doctor who actually delivers them , depending on how long that process is right , especially an induction , who might start out .
I mean , you can tell people are used to that when it makes it on tv , because you remember what's the movie where the guy knocked up that girl . Was it called knocked up ?
catherine heigl . Yeah , was it Seth Rogen and Catherine Heigl ?
remember I never saw that movie , but yeah , I've heard about it yeah , but basically they have an effect or they have a one night stand . Long story short . She goes and meets with different OB , or sorry , she meets with her OB , develops a relationship with the OB and then , when it's time to deliver , that OB is not there , it's somebody else .
And now they got to navigate through the emotions of specifically for her . I've been with this one OB for I don't know eight months , nine months or however long , and now there's somebody else new who's going to deliver me . I don't know you yeah , I didn't .
I've never seen seen that movie . I didn't know that was part of it . But yeah , I mean , I think that people are used to it . I like I have had patients right where I work now be like , are you in the ? Have I seen you in the office before ? And I'm like , nope , only work in the hospital .
And they're like , okay , because I know I haven't seen you before . I'm like , yeah , no , I only work in the hospital and I haven't had any issues . I've never had a patient go . No , I want . Well , no , that's not true . Actually , I had one patient who was like extremely distraught because she wanted one of the partners in particular .
She wanted one of the partners in particular to deliver her . And I was like , well , he's not on call , right , like I'm on call . I'm like , don't worry , you're going to be fine . X , y and Z . By the end of it she was like , oh my God , I'm so happy you were my doctor . Blah , blah , blah , blah .
So you know , I think that , yeah , that's part of it is navigating . You know , helping patients navigate through the emotions , particularly on OB , that you're going to come to the hospital and it's not going to be necessarily the doctor that you've seen in the office , that it might be somebody else .
And I'm sure there are other specialties like that .
¶ Doctor Transitions During Patient Care
Do you think it's a chance that it could lead to laziness or kicking the can down the line ? Like , is there going to be ? Like , do you see that at all when ? Ok , well , I'm only here for a couple of days . I don't want to do anything too definitive , so let me wait till somebody else comes on and go from there .
I'm going to tell you this and I know the doctors are going to be up in arms when I say this , but I actually , thankfully , where I work right now , everybody is great . I've never had a can kick down the road , but I have been in other places where the can has been kicked down the road and you know , kicks the can down the road .
The traditional practicing docs .
Oh , so the ones who you're relieving , the ones who are there for who are there , they're employed and they are for the weekend , doc , it's usually the traditional practicing doc , and I say this not as an insult , I say this because of the question that we are answering right , and I've said this before on the show right , where you're doing a lot , you're doing
a lot right , and so now you've got to reckon with the fact that you are on call and all of this craziness is going on . It's midnight , it's one in the morning , it's five in the morning and guess what ? You know where ? You got to be in a couple hours In the office , in the OR , in the somewhere right .
If you're lucky , you get to be off on that date . That's if you're lucky , because not all practices work like that , cause I was at a , you know I was at a hospital where the doctors didn't have the 24 hour , you know the 24 hour , call on and then have guaranteed 24 hours off .
So I've seen that and again , not to be insulting , but you got to avoid a little bit of work so that you can conserve your energy , otherwise you're not going to have energy to be able to see patients in the morning and for the entire day , because you didn't get time off between your call and going back to the office or having to go to the OR and do a
full day's worth of elective cases . So yeah , that's where I see kicking the can down the road . But what that says to me is yo , these doctors
¶ Burnout and Kicking the Can
are tired and we need another solution .
The doctors are tired , and the doctors are tired .
We need a solution .
I don't see it as much as folks think that it occurs . It doesn't occur that much , but that's a leadership problem in my opinion . Right , that's a leadership problem .
You have to have a strong person who's leading the department , who is plugged in , who shows up at sign out consistently may not need to be there daily , but who's there and kind of knows the pulse of what's going on with the program , what's going on with the patients , and can say , hey , like you guys talked about this on Monday , why are we still dealing
with this on Friday ? Right , and it's not a you have to do X , y and Z type of thing from that person , but it's a God , it's like we've been talking about this issue . I'm observing something and , as the department lead , or as the chairperson , you know , I got to step in and say like , are we really doing what's right for the patient ?
That's what I think right .
Yeah .
So I do agree with you . I do oftentimes see if I'm relieving someone who's there , who's employed .
Who's permanent ?
Permanent . A lot of times it's like well , you're the locums guy , You're going to come and handle everything they're going to pay you a certain amount and then you get to leave .
So like we're going to work the hell out of you for a weekend , or we're going to work the hell out of you for 24 hours , or we're going to work the hell out of you for 24 hours and you're going to be able to go away and you'll recover , you'll be okay .
So yeah , I do see that , but with everything that is good with shift work , there are some things that are bad . You just got to take the good with the bad and I think that overall , provided that this is what you're really passionate about , this is what you really enjoy to do .
Right For me , I enjoy surgery , but , to be honest with you , I really enjoy taking care of people when I don't know what's going to happen . I know following an algorithm works for me . I know that there's the practice , there's the art , I know that there's the bedside manner , but this is what I'm really really good at and that's where I really for me .
You can even tell like my juices get going in trauma . The juices for me get going in critical care . I really like acute care surgery , but if you really had to put me down what I really really enjoy , I really enjoy trauma and you know , I feel like we all in some form or fashion .
I really wish that we got a window into this while we were medical students as well as young residents ,
¶ Finding Your True Medical Passion
so that we can start positioning ourselves for this , so that when we hit the ground running as attendings , we kind of know what moves to make .
But you know this , is this a resident . I thought that I would like office . I really did . I enjoyed office when I up was that you know , you'd go to clinic and you didn't always follow up with your patients , right , there was always somebody else who was doing the follow-up , right , and so it just wasn't the same . So you had this window , but it was .
You know , it was tinted . You know the window was tinted , you know . So we had our . There was an attending who you know she would go through a lot of the labs , right , she would go through a lot of the tests and the ultrasounds and everything .
And because of the way our residency specifically was set up , you might be in clinic these months at this particular site but then you might be a clinic at another site for these particular months . So you really actually couldn't do the continuity in the way that you really wanted to do it .
You know there were some patients that you would follow up with , yes , but it wasn't so consistent that it could actually give you a real , real window into what private practice was going to look like . So , you know , I thought I was going to enjoy office until I actually had to do it as an attending and I was like , oh , this is for the birds .
Oh , for me . For me , that's what I thought also , but I'll tell you one . I realized I didn't like clinic was when we were working in Kansas together , when we were working with Dr Durrett .
I love the surgeries . Please and thank you and things .
I didn't like the clinic at all .
I didn't like the clinic all , I didn't like the clinic I didn't like that .
I understood it . I was like okay , this is where he's getting his patients from . This is where he's following up with his patients . That just wasn't the part that I really enjoyed . I enjoyed everything that happened in OR . I enjoyed seeing the inpatient consults . Even you know , like the referrals , I enjoyed that stuff .
But I , the inpatient consults , even you know , like the referrals , I enjoyed that stuff . But I just I don't know .
But listen , jamar , good question , man Keep up with giving us these really great questions . Um , I hope everybody else .
You know everybody else . Listen , you know Jamar sends us messages on . He sends us a text messages , right ? So that's located in the show notes . You can also email us . There's also something called fan mail , where you just click on a link in the show notes and you send us a message . So there's multiple ways . It's Instagram .
Some people even send us messages on YouTube . They see our videos on YouTube and they respond and they will have a question there . So , listen , we take all comers . Wherever you're consuming this information , you know where to find us . Send us questions .
We'll come after and look at those questions and let you know when we're going to put those episodes out there . So any parting words you want to say before we get out of here .
I do have a question for the audience of you who do traditional practice and you are
¶ Inbox Management and Final Thoughts
bogged down with your inbox in terms of looking at labs and looking at all these different results , knowing that majority of your results , specifically for primary care , that knowing that majority of your results are going to be within the normal range , would you be comfortable if you had another qualified physician who could look at those results and essentially weed
out all of the norms for you so that the normal values are looked at , norms for you so that they are the normal values are looked at by a qualified physician in your specialty , look those you know up and essentially say , ok , this is normal , this is normal , this is normal , so that your inbox only has the ones that are abnormal , so that you can deal with
those . And I ask that because that was a gig that I had once .
In essence , guys , would you be cool with having a locums ? Basically focus on the clinical labs , like the labs that come in clinic and look at everything that's there when they come in after hours and kind of alert you if there's something that's out of whack . If they're normal they don't really show up in your radar .
But if they're abnormal .
They'll kind of do the things that you need to do .
Yeah , I got you . That's a good question , so I'd love to know what the audience thinks about that .
For the record , I met another doc who transitioned to locums just recently .
Transitioned to locums just recently um anesthesiologists working at a really large hospital system for majority of of the career and decided recently wanted to do locums and has really enjoyed it and was telling me how their their partner is saying man like I see you more , even though you're traveling more , I see you more you're more plugged're doing things together .
Listen , we're not locums fanatics , you know . Obviously we're fans , but we're not fanatics . But I think the writing is on the wall .
Isn't fan short for fanatic .
Oh yeah , that's a good point . That is a good point . We're fans , but we're not guys we are going to jet because I have to go back into the hospital speaking of , uh , the work following you . So listen , we're going to catch you guys on another episode thank you , jamaa , for writing in and we'll check you guys on the next episode .
All right , y'all peace peace yo um , we are both tired .