"There is an increasingly pervasive sense not only of failure, but of futility. The legislative process has become a cruel shell game and the service system has become a bureaucratic maze, inefficient, incomprehensible, and inaccessible." - Elliot Richardson Lately, I've been spending much time pondering my own personal transformation from pre-med student, to med student to resident. I've undergone so many changes in the space of the past 6+ years, that I feel in some ways like an entirely new person. I can recall when I made the decision to pursue my dream of becoming a doctor. I envisioned a career where I cared for and helped patients every day. I imagined myself saving lives and impacting lives through my daily work. I still believe that this is my ultimate goal, and that it is attainable at some level, but I can feel cynicism creeping into my brain, fueled by the frustrations of my daily work. I was recently ask to begin leading discussions with groups of medical students where I provide an open arena for third year students to vent their frustrations with the transition from studying the basic sciences to the world of clinical medicine. In those discussions, I've noticed that several themes routinely surface. One of them has to do with the reality of medicine and healthcare. Being a doctor and providing care to patients doesn't just involve the actual technical aspects of medicine, which is what is primarily taught in med school. The reality is that it also involves understanding and appreciating the healthcare machine and conforming to administrative standards and requirements, the most paramount of which is the "P" word: Paperwork. I believe that this issue is perhaps more prominent in the United States, versus other countries. But as I've only practiced medicine in the U.S., I can't speak to other healthcare systems on a personal level. At this point in my training, I've come to the unfortunate realization that only a small portion of my time is actually spent caring for patients. And out of the time, which is spent on clinical care, an even smaller proportion of that time is spent at the patient's bedside. The majority of my time is not spent saving lives or even making clinical decisions. Rather, it's spent documenting what I've done, or plan on doing. And it's not just the documentation. It's a seemingly unsurmountable mass of other administrative and bureaucratic realities, guidelines, deadlines, policies and procedures. Sometimes the red tape strangulates my fingers to the point that it feels like a tourniquet applied to my soul (yes, I can be dramatic sometimes). I don't have a perfect solution to my frustration and have found that I tend to just "go through the motions," and try to focus on the larger picture at hand. However, I think my biggest fear is that I might continue to become more and more embittered towards "the system" as I progress through my education and my journey in medicine, and that this feeling will eat away at my own personal fulfillment and possibly at the quality of the care that I provide for my patients. I think that all I can do for now is cross my (strangulated) fingers and hope. Or perhaps I should keep a reminder note scrawled upon the red tape on my fingers every day which says, "yes, I can." Source
