Scut work takes away from a physician’s inherent joy

Most physicians love the profession.  Our medical students and residents want to care for patients, interact with patients and help those patients.  For most physicians, the joy of medicine occurs at the bedside and while investigating patient problems.  The joy does not extend to scut work (defined in the free dictionary as “trivial, unrewarding, tedious, dirty, and disagreeable chores”).

Now who defines scut work?

Back in the 70′s, we would define scut work as drawing blood, carrying said blood to the lab, wheeling patients to x-ray, or starting IVs.

Today, scut work involves some of those issues, but more commonly filling out forms (especially pre-authorizations and anything an insurance company demands), writing notes and orders in the electronic record, writing notes that meet billing requirements rather than notes that convey important medical information.

Scut work, as physicians define it, remains the bane of our daily lives.  Katie Hefner’s excellent New York Times article, “A Busy Doctor’s Right Hand, Ever Ready to Type,” addresses the documentation issue nicely.  Chris Sinsky adds more texture in her important Annals of Family Medicine article: “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices.”

Being a physician is inherently joyful.  We awake each morning, look at ourselves in the mirror, and understand that we have an opportunity to help patients today.  Then we get to the hospital or the office and the scut work takes over, deflating our optimism.  For over 40 years, I have heard residents, students and attending physicians talk about how much they like interacting with patients and how scut work dominates too much of their time.  They consistently express a desire to do the things we train so many years to accomplish.  Doing the other stuff discourages physicians and therefore patients and patient care can suffer.

We must all focus on the joy of medicine and work on ways to enhance that joy.  Our profession is too wonderful to do otherwise.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • Ron Smith

    Hi, Robert.

    The practice of medicine can be pleasing, but ‘joyful?’

    I guess I”m in an alternative universe. I can understand well checks. I love seeing new families, but the hardest thing to see is illness rip them up and have their way with them.

    I see sick patients and parents for a piddly fifteen minutes and somehow in the middle of the common sleepless baby or ear infection or flu, compared to the uncommon aniridia, nasal encephalocele, CH50 deficiency and myriads of other ‘uncommon’ things that seem to ‘commonly’ occur or that is supposedly to translate into joy? All those are just very recent practice history.

    Please excuse me while some of my emotional seams are questionable. I just went this weekend to spend a delayed Christmas with my 83 year old father with stage 4 lung cancer and my 80 year old mother in constant pain with inoperable, degenerative kyphoscoliosis and bone demineralization who’s trying to take care of him.

    If you stay in this profession for very long, it will eventually smack you in the face with a reality mud pie!

    Now that doesn’t mean you shouldn’t take joy in what you do, but honestly, I have emotional tolls with those patients who are ill. Do I remember the scut work? After thirty years and chugging on, it doesn’t occupy a moment of my thought.

    There is this constant rumble, a low-pitched hum, from which I know comes from the fact that we are so frail. Medicine will ultimately lose the war no matter how many battles we win. Practice is not about career, but living your life with your patients I think.

    Scutt work is well, just a diving board into the real water. Its a necessary part of the experience. All who dare these waters should make sure they are informed.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Allie

    I think we should do a better job being involved in genuine advocacy for ourselves against the corporate an bureaucratic forces that are creating the environment we care for patients in rather than just being idealist about what a pleasure it should be to care for patients.

  • NPPCP

    Liberty, you hit the nail on the head!! Physicians should not have to sign off on the work of others. It is a meaningless exercise in futility that does zero to improve quality of care or anything else. At the forefront of the meaningless is the “medical home”. Who would want to lead a home just to be the captain and then have all of the responsibility placed in their lap? The whole thing is ludicrous. Let every healthcare worker take their own responsibility for their own actions. Great post!

  • NPPCP

    “Scut work” is part of the job. Everyone has some kind of scut work in their lives and it is a part of working life. Frankly, when I read the title of the post, I thought “why does it say physician’s?” Why doesn’t it say “worker’s” or “business owner’s” or “nurse practitioner’s” or some other variant? Physicians hold no special place in this life to avoid routine menial labor, i.e. paperwork or whatever. This is part of the daily job. All hard working individuals should be respected for their place in life and the tasks they perform. I just don’t understand why it would be any different for any one profession above another.

    • NPPCP

      “All hard working individuals should be respected for their place in life and the tasks they perform.”
      Two thumbs down for this – and you all wonder why medicine is where it is.

    • southerndoc1

      Other professionals, such as lawyers and accountants, very appropriately bill for their scut work.

      I don’t know any other group that is expected to provide unlimited hours of free labor to for-profit organizations such as PBMs.

      • NPPCP

        Good Morning Southern! I posted that last comment under the assumption the OP is complaining about doing ANY scut work. The way I read it, they just want to walk in rooms, take histories, diagnose, and treat. I wasn’t thinking about getting paid or not getting paid for performing scut like activities. I agree with you completely.

  • John C. Key MD

    Robert I can’t tell if you are “for” or “against” scut work. I trained at a school which required fairly extensive scut work–not only did we draw the blood and start the IV’s, we hung and changed the fluids if we expected the IV to keep going; and in that pre-EHR era we made out the lab slips and imaging requisitions if we expected them to get done at all.

    Oh, I didn’t like it too much at the time, but it taught me basic skills and and responsibility and allowed me to see irresponsibility (hopefully in others) and it showed me how the system worked and how to keep it working.

    I think that all scut work involving clinical tasks, however mundane is helpful. I’m glad I had to do it. Today it gives me joy.

  • http://www.myheartsisters.org/ Carolyn Thomas

    Maybe it’s time for a “Take Your Physician To Work Day” for a wee dose of reality in the vast majority of other workplaces out there (and not just for lawyers and accountants who track those billable hours). I used to compare my own 30+ year career to motherhood – in which you love the baby, experience pure soaring delight in many aspects of caring for the little darling, yet sometimes despair because of the mind-numbingly exhausting, maddening tedium. Mums don’t call it scut work, however. It’s just part of the parental job description.

    Please show me any occupation that has one (joy) without the other (scut). Do they even exist?

    • Suzi Q 38

      You could be a plumber and climb underneath houses to clean out the sewer drains….Construction worker mixing and pouring cement….forklift operator….hotel cleaning person…..etc.
      Things could be worse.

  • T H

    I approached the ED director like this: If you want me to do all of this excessive paperwork (pre-auths, insurance forms, etc.) and not see patients, I am glad to do so because you’re already paying me by the hour. However, if I am doing the paperwork, I’m not seeing patients…. which is what brings in the money. She took it up with administration and the ED got one more clerk to help out. Didn’t make a darn bit of difference because it’s like trying to hold back a flood with a 2×4 and a bit of tape. But they listened (only) because it affects the bottom line.

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