a few notes on office politics

It's no surprise that patient care suffers when there is drama in the hospital workplace, but it's distressing how common that drama is. A few suggestions for improving the often petty environment of the medical hierarchy:

#1: Divide and Conquer.
One of the most annoying aspects of working on L&D is that no one is assigned a particular patient, and as a result, everyone competes for the "interesting" patients, leaving the mundane (and thus the most commonly encountered) patients out in the cold. Triage the patients as they come in, and assign work/patients by rank. The medical students can do the triage and other scutwork, interns can take the more simple cases, and senior residents should work or supervise more complicated cases. This schematic requires strict dedication to rule #2:

#2: Maintain upward mobility.
I once read this piece of advice in a magazine for getting your dream job: "Don't become too good at the small things." Same thing goes for medicine. You can't keep people at the same level of intellectual challenge, no matter how competent that might make them. After all, older doctors must retire, and younger doctors must replace them. I firmly believe that part of the reason that senior residents get so greedy with patients that ought to go to junior residents is because they don't have anything better to move on to themselves. Yes, I know not everyone can be Chair of Medicine, but it's medicine! There is always something to be done! Get more people into administration, encourage them to do research, force them to do didactics... really, there is no limit to the tasks you can push your doctors to do. It increases productivity, expands the scope of your program, and most of all, decreases dissatisfaction in the workplace!

#3: Education should be a priority.
No joke, my resident's main piece of "teaching" to me my first day was, "Antepartum means before birth, and postpartum means after." Um, I already knew that, I took Latin in high school. Even though I've been only through 3 rotations to far, it's quite obvious that some residents are good teachers and some are utter crap, and the sad thing is, it only takes doing a few, non-intensive things to be a good teacher. First, allow your med student to take the history on the patient and - this is the part many residents leave out - offer their opinion on the diagnosis. Make them argue for their choice, and if they don't have good reasoning, make them do a homework assignment on the differential. (I know, I'll regret this once I'm on surgery and internal and zero time for anything). Second, just take the 30 seconds to ask, "Do you understand what I'm doing and why?" Or, "What do you know about [insert diagnosis]?" We're med students, we forget a lot over a course of a summer. Third, if you have time, make it a priority to teach at least one clinical pearl a day. All this literally takes mere minutes, and will save you time in the long run as your student becomes more competent and thus doesn't have to badger you for info every other minute. Genius? Or just common sense?

That's it for now. I know I haven't been doing posts every other day like I said I would, but honestly, time has just been flying, and I'm not even keeping track of the days. I'm on call tomorrow from 7 am - 7 am, and this is nerdy, but I'm excited. I'm really enjoying ob-gyn, despite my complaints about the office politics. Could ob-gyn be the field for me??