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Pete Wung's avatar

Excellent contant David. I particularly liked the senate idea, where top management is not allowed. Putting people at the same level definite helps. No one is looking over their shoulders to parrot what ever the boss says. Yet another book atop my TBR pile.

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Ryan McCormick, M.D.'s avatar

A really helpful interview and framing here, thank you! I had a lot of thoughts related to the practice of medicine, and especially the teaching that goes on during our residencies. Some of the kind v wicked characteristics are ingrained in the situation, and therefore harder to improve. For example:

"rules might change (if there are any)" - in medicine we are always trying to learn from evidence-based trials, observational studies, and the authoritative meta-analysis. Rules change a lot, and for good reason. But telling a practitioner to stop prescribing something that was once thought beneficial but not proven harmful leads to a lot of internal struggle. The ever-changing and expanding rules of good practice are often more than any one individual can keep up with, too. People fall back on their experience, especially older physicians.

"patterns don’t just repeat" - another inherent wicked part of the job. Postpartum bleeding might be mild uterine atony (treatable) or disseminated intravascular coagulation (a catastrophe). Chest pain might be too much pickleball, or an ongoing heart attack. Stress and uncertainty are constant.

"feedback can be delayed or inaccurate" - good feedback in medicine only occurs during residency training or in academic centers, if then, and when you're out in the world practicing, you're pretty much on your own, cramming in patients and maximizing productivity for your new business-oriented overlords. I would love to sit back once a week and examine, reflect upon, and learn from my experiences, getting clinical feedback from my colleagues. Instead we are cloistered in one small examining tomb, err "room," after another, and rarely come up for air. Maybe we get a monthly report on quality-of-care metrics like how often patients reported that we washed our hands. Great.

"and work next year might not look like work last year." - queue pandemic. Feeling like a coal miner going into the mines each day, strapped into a face mask and exposed to risks of disability, disease, and not to mention patient skepticism/disdain of your tools (vaccination, treatments, etc). The only constants are unmanageable workloads and the threat of malpractice. Ouch to write that.

Sorry, quite a tangent here, and not totally what the author is talking about, but somewhat therapeutic for me to write anyway! I'm not burned out myself, but apparently the majority of doctors are right now, signaling a systemic disease in our collective body. A doctor a day is committing suicide. And with healthcare consuming 18.3% of our GDP, fixing this problem is beyond the ability of any small band of physicians with self-preservation and systematic-improvement in mind. The MBA's have ascended to the drivers' seats, and the buses are run by insurers, administrators, and pharma.

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