Anxiety - Underlying and Insidious

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I can always tell when the anxiety is getting bad. My dreams get extremely strange or violent. Usually I am not committing the violence; instead, it is happening around me. My husband notices because I sleep very deeply and either snore or breathe very deeply, loudly, and heavily.

The source of the anxiety this week is my work. I am providing at-elbow support for physicians as part of a go-live of the electronic EMR in certain areas of the hospital. Technically, it isn't the hospital, it's the group of physicians who have admitting privileges at the hospital and their associated clinics.

Doctors are a strange breed of human being. Our society raises them in such a way that encourages antisocial behavior in the workplace.

Disclaimer

Before every doctor who has social skills and does, in fact, behave like a grown-up in their professional milieu takes offense - get over yourselves. You know this type of attitude and behavior is prevalent in your field. It's certainly prevalent in other high-value fields where people think they are deserving of special treatment (or normal treatment, as they see it). You know, like politicians, celebrities, etc.

Medical Office Culture

I don't think it's right to hire people whose job it is to make sure you don't get upset and you are happy. I don't understand why people tolerate this kind of work, especially thoughtful intelligent people. I don't understand why nurses minimize their independent practice of nursing to the emotional and logistical coddling of a physician.

No, I'm not moving to a medical office any time soon. I doubt they would hire me, anyway.

U.S. Medical System

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The defense of this behavior is the economic reality of our medical system in the US. The physician is the money maker. Physicians hire support people so they can maximize their hours billable at the maximum rate. Therefore, it is fiscal irresponsibility to have a doctor do such a "menial" task as fax a prescription refill to a patient's pharmacy. Or so they say.

It's a better to hire a secretary for this.

But our system places responsibility for the decision to prescribe on the physician, and it is illegal for their support staff to prescribe. We've worked out an elaborate proxy system that the physician minimizes the amount of time considering the prescription. In other words, the person who really makes the decision whether a prescription can be refilled is the medical assistant, the physician's assistant, the professional nurse, or the practical nurse, and in some cases, the secretary (not medically trained). They do all the logistics so the pharmacy can dispense. The physician gives her stamp of approval at a later time, maybe in some cases, after the med has already been dispensed.

Don't get me wrong. These people are thoughtful and through their experience working in the field, they develop an understanding of the conditions, the course of illnesses, and standard treatment protocols, and they know the patients. Workers who learn in this manner are effectively apprentices. However, we don't do apprenticeships in the USA, we do university degrees and certifications.

That's the dichotomy that causes me so much disdain for physicians. They expect their staff to be smart and trustworthy and loyal, but the second they overstep their bounds, they thump the staff person on the head with "you're not the professional here." Bullshit. The trust must go both ways, or the physician should do this stuff themselves, and actually take care of the patient holistically.

American Royalty

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Back to the antisocial part. Maybe what bugs me about this is that when I argue that my time is valuable and high dollar value, that is scoffed at because we all must pitch in.

Doctors don't have to pitch in.

The physicians received some pretty damn expensive at elbow support from me. I am an expert at analysis, design specifications, and strategic development of information systems. And I am sitting around waiting for them to verbally abuse the organizational changes that force them to change their work habits. Who is the thing you can yell at? Me, the messenger....I receive the vitriol.

What really makes me angry and gives me stress is that I must accept this castigation about a system that I had no involvement in designing or building. I defend decisions I did not make and in many cases do not fully understand. Furthermore, I have limited power in changing the system to coddle the physician.

When the physicians understand the whys and wherefores behind the organizational changes it's not bad at all. When they are the spoiled children who whine when they don't get their way, it's hellish because I cannot treat them as the over indulged, princes they act like.

In my observation, it's mostly the men that act this way. The women tend to be a little more team-oriented.  Yes, yes, there are exceptions on both sides of the argument. I'm merely commenting on my experience.

And what really twists the knife for me is that what I know about the software we're using, it's so freakin' physician-focused that I don't know why they complain about anything! The rest of the staff is (metaphorically) using the system in Hebrew, on a monochromatic CRT screen, with one arm tied behind their backs and a boxing glove on their remaining one hand, to make the physician workflow work "effortlessly," and the physicians have the balls to bitch about how awful the system is?

My God! The system doesn't read my mind. It only does what I told it to do. It must be crap!

Spoiled. Little appreciation or understanding of the bigger picture and the role of the team that got them to that point.

But when they receive the check from the government for Meaningful Use achievements, they will pat themselves on the back to say what a great job they've done.  When they publish the research based on data that they merely extracted from the database in a single query in 2 hours, they will receive accolades on how clever they are.

I have a lot more to say to work out this anxiety.