How much longer?

How much longer?

How much longer?

How long can we continue to serve this broken system? Many of the day-to-day events that suck the joy out of my life are small, petty events.

Drugs in critical shortage or equipment on back order, staffing shortages, a ‘full’ hospital despite empty rooms because there aren’t enough nurses to cover them, an Electronic Medical Record system that is counterintuitive and user hostile but is nevertheless mandated by the Federal bureaucracy, and a ‘lowest bidder’ purchasing system that leaves us with ’good enough’ but not optimal gear.

It’s a death of a thousand cuts, each one a small thing, almost trivial, but cumulative. You compromise a little here and a little there, you tell yourself ‘it’s good enough’. Until one day it’s one compromise too many, or worse, your patient suffers a complication because something wasn’t done right, or you missed a key lab in the blizzard of information that floods your computer feed every morning. Then you explode and now the issue is your ‘disruptive behavior’ and not the system failure that drove you over that edge. Some days I feel like I function mainly on rage and caffeine.

Complaints to Administration seem to fall on deaf ears, but I know they have their own pressures. Budgets and regulations, Medicare rules and threats of funding cuts, personnel shortages with no prospects for quality new hires. No one has good answers.

So, I try to carry on, to maintain my zanshin, my state of relaxed alertness, my zen. Then I get hit with a coding query from a bean counter who has never seen a real patient. Or the good idea fairy at CMS decides that we need to document serum porcelain levels on all Medicare patients, but our lab doesn’t do serum porcelain in house and has to send it out and by the way, it’s not covered by Medicare Advantage (those heavily advertised plans that offer extra bennies at no extra cost). And the cycle of rage starts all over again.

The current popular psychology term is ‘moral injury’. The National Center for PTSD has this to say about moral injury: ‘Moral injury usually involves experiences that contradict an individual’s personal or shared values or expectations, such as having to make decisions that affect the survival of others, having to make decisions where all options will lead to a negative outcome, engaging in an act of wrongdoing, failing to prevent serious unethical behavior, witnessing or learning about such an act, or betrayal by trusted others.’

Our current healthcare system is rife with it. Every day we are forced to make compromises. Compromises that we know at best cause us to give our patients less than optimal care, at worst place them at risk for bad outcomes.

So, we carry on because for most of us, life is service. Our patients are the reason we went into this profession, and they need us. We do the best we can, ignore and override the misgivings, accept the compromises, because we can’t change the system.

How much longer?


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