How administrators can earn the respect of the medical and nursing staff

Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing at Blair General Hospital.

Thanks to my mother, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B, and he was a legend in my home state of North Carolina.

My mother was a nurse anesthetist in the Raleigh hospitals where the Duke medical students, interns, and surgery residents trained. She said everybody viewed B as “the most talented student ever to attend Duke Medical School, and on top of that, the nicest person you ever met.”

This was the 1940s, a time when many of the medical school faculty left to serve in the war effort. B was such an outstanding prodigy that he was recruited to help fill this gap, functioning essentially as a faculty at the same time that he was a student. When he became a surgery intern and then a resident, hospital administrators made him their “go to guy” for every job that needed to be done.

My Mom said that Dr. B was a paragon of virtue and the over-achiever’s over-achiever. People wondered, “How does he manage to do so many things, and to do them so well?”

What they didn’t realize is that while he was a superhero on the outside, he was suffering on the inside. He was too nice a person to say “no,” and the medical school and the hospitals literally worked him to death.

Early one morning the perioperative team entered the OR to discover a bizarre sight. The room had been trashed and somehow the large, steel OR table had been cut in half! That’s right. Cut into two pieces. Right down the middle.

The hospital where this happened was Dorothea Dix, one of the largest psychiatric institutions in the United States. The first thought was that a group of “inmates” (the term for patients in those days) had gotten a hacksaw and taken turns sawing all night long. Even with a group of men, this would be an incredible feat of passion and strength.

It turned out that all this was the work of one man, and it was not a patient. It was a surgery resident and superstar physician: Dr. B.

They hospitalized him at Butner, North Carolina’s other large psychiatric hospital. A few days later he was found dead in his room. He had hanged himself.

My mother, and all those who worked with him, considered Dr. B the best there ever was. He could do any job assigned to him, and do it better than anyone else. The one thing he could not do, however, was just say “no.”

Dr. B’s death had a profound impact on my mother. By nature, she was a hard worker. But after Dr. B’s death, she worked on her own terms.

On at least a dozen occasions my mother told me the tragic story of Dr. B, and with it the lesson she learned:

If you do things well, you will always be asked to do more, until you reach the point where you no longer do things well. You’ve got to know when to say “no.”

This may sound easy, but it isn’t. Most doctors (and nurses, too) have the “altruism” gene. They get more satisfaction from helping others than from helping themselves. They get more satisfaction from having healthy patients than from being healthy themselves.

Doctors also have the over-achiever gene. Ask them to perform at a certain level, and they’ll go two notches higher.

Meanwhile, health care organizations eat their young for breakfast. They take the best and the brightest — like Dr. B –and they work them to death. They’ve got a fleet of Maseratis, but they treat them like clunkers. They’re only thinking about making this month’s “targets,” so they don’t take time to change the oil, check the tires, or lube the moving parts. They simply drive them into the ground.

The only thing most health executives know to do is to ask their doctors and nurses to do more. Have you ever heard of productivity quotas being lowered? Have you ever heard of “new normals” being lower than the old normals?

It’s that shortsighted vision that killed Dr. B, and it’s why physicians today have the highest suicide rate of any profession. Doctors are too nice or too over-achieving to just say no. So instead they just off themselves. They just say no to their own futures.

Those who end their own lives are the tip of the iceberg. Underneath the surface is a much larger group that is contemplating a different type of suicide: career suicide. One-fourth of U.S. physicians say they are seriously considering quitting the profession they once loved. Not because they are old enough to retire, but because they are burned out, and they don’t enjoy being doctors anymore. Ask them why, and they’ll say that medicine has lost its soul.

Being a doctor used to be about patient care and quality of care. Now it’s about quantity of care. And paperwork: documentation, data entry, and meaningless CYA tests. Today’s physicians spend more time typing into their laptops than talking with their patients.

Doctors are smart, so they make great data entry specialists. But this isn’t why they gave up four years of their life for medical school and another 3 to 4 for internship and residency training. They want to care for sick and suffering humanity. They don’t want to waste their time checking boxes on computer screens or practicing assembly-line medicine. Patients don’t want this either.

As my mother never ceased to remind me, it was insanity that killed Dr. B back in 1950. Not his insanity, and not the insanity of the psychiatric patients, but the insanity of the hospital administrators and the health care system. They took the best young doctor they had and worked him to death. They killed the goose that was laying golden eggs! Who in their right mind would do such a thing?

If my mom were around today, she’d say we’re doing it again. Except this time it’s on a much more massive scale. We’ve got a physician suicide epidemic, a physician burnout epidemic, and physicians quitting the profession at unprecedented rates. Something dysfunctional is happening, and it’s time we took notice.

I have a modest proposal. I call it “Take An Administrator To Work Day.” One day per month, hospital and clinic administrators should turn off their iPhones and spend a day following a doctor or nurse. They’ll see how hard these clinicians work, which factors make their work effective and satisfying, and what values drive their motivation. They’ll see the difference between quality care and assembly-line medicine. They’ll realize that it’s not about numbers and dollars, but about patient care and public health.

Administrators who do this will earn the respect of their medical and nursing staff. They’ll learn how to do their jobs more effectively. And soon they’ll find themselves pulling in the same direction as the clinicians they serve. Once they have observed and listened to their clinical colleagues, they’ll even be able to share their own challenges and frustrations, values and priorities as executives and administrators.

Once these walls come down, health professionals and health administrators can begin a truly collaborative effort to build health care organizations that provide excellent care for their patients and satisfying work environments for doctors and nurses — without ignoring the bottom line.

Warren Holleman runs a wellness program for physicians and is on the editorial staff, Pulse — voices from the heart of medicine. He blogs at Work Well.  Be Well

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