FIRE, Louis, and Me

I don’t know how things are going where you work, but around here, nothing is working as well as it used to.

In clinic, it’s a day-to-day announcement of whether we have enough staff to offer all the services that used to be standard: nurse-driven care (injections, infusions, wound care), an assistant to room the patient, help with prior authorizations. Don’t even get me started on whether patients are scheduled properly (15 minute new patient physicals, anyone?)

The hospital isn’t exactly a haven, either. I recently spent several weeks on a ward that had closed during the pandemic due to staffing (so many nurses left that the ones remaining couldn’t handle it). The ward has reopened, but is staffed solely by agency nurses. They are good nurses, but don’t have any of that institutional knowledge that lets people come up with good workarounds when the poop hits the fan. I saw the unit secretary recently; she’s been there over 20 years, and is scared to think that she is the go-to person for these nurses. (I think she is awesome, but she isn’t a nurse, and worries she’ll give bad advice.)

More elective procedures are no better, and probably worse. A patient messaged me that they had called multiple times to schedule a routine colonoscopy, and after 2 months, hadn’t even been called back. I had to e-mail someone I know to get them called. Lest you think connections are everything, a well-established physician (who also happens to be a patient) wasn’t able to get non-emergent imaging for several months.

As you may well imagine, all of this craziness makes work a lot less pleasant.

Fantasies of submitting my resignation become more frequent, usually popping into my head as I find yet another challenge due to our staffing woes.

For all the blogs out there talking about the meaningless drone of their paper-shuffling careers, most of the people I work with do important work. What they do affects lives (I mean the patients’ lives, not mine. Though the latter is true, too.)

I suspect that we might be able to get more staff if we paid better. However, sometimes the work is overwhelming: angry patients and family; nice patients and family but heartbreaking diagnoses; too many phone calls; too many forms, with too few people on the other end to grease them through to completion. Sometimes life outside of work is just too much. I don’t know how long it will take–if ever–to feel that clinic and hospital are fully staffed again.

In the meantime, I worry how we are going to get everyone taken care of.

I keep bulling ahead, doing what I have the energy for. But at some point, I (and others) will throw up our hands and decide we can’t do it anymore.

I think of France’s Louis XV, and his phrase Après moi, le déluge.  Or, put another way, once I’m gone, who cares?

A young boy dressed in fancy clothes, ermine robe with France's fleur de lis, sits on a throne with his foot on a pillow. Louis XV, King of France, as a child.
Portrait of Louis XV as a child

What will medicine look like if we all do that?

How is it going where you are?