People, not computers, make health care work

Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days.

“Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.”

“Good to know. We may have to change the dressing more frequently.”

“And this patient had constant diarrhea overnight. Pretty much every hour.”

“Oh, really? Let’s try changing the diet and see if it helps.”

I relay these updates to the rest of the team during our morning rounds. This is where the events from the night are formulated into care plans for the day. After rounds, the physician assistants and I break off to place these orders, call the necessary consults and perform minor bedside procedures. We click the buttons aimed at measuring or altering patients’ bodily functions — e.g., “Please do not give the patient anything by mouth” or “please discontinue the patient’s’ stool softeners.” It takes about an hour for us to check off our to-do list.

As a physician working in a system that is so well-supported by other staff — including RNs, CNAs, NPs, PAs, PTs, RTs, social workers (the list goes on) — I have gotten spoiled over the past months on Ravdin 6, Founders 5 and the cardiac and thoracic surgery units at the Hospital of the University of Pennsylvania. It is a luxury to know that when the team places orders in the morning, they will be carried out seamlessly by the wonderful staff here, no matter how difficult or sensitive the requests may be.

Being so well-supported, it is also easy to develop an illusion that every order I place quickly magically transpires into the outcomes I desire.

But this could not be further from the truth. Health care delivery is not magic. It takes just a quick stroll around the floor to remind myself again that the nurses and other staff are to patients as Atlas is to the Earth. The reality is placing the orders is only the beginning within the long continuum of patient care. Clicking a button is easy. The execution of the task is incomparably more time-consuming, arduous and, at times, exhausting although these aspects are too often taken for granted.

It is also what matters much more to patients. Until someone physically administers the medicine, measures the urine, changes the dressing on an infected wound every hour or cleans up the diarrhea, an order only exists in the abstract signifying nothing. The nursing and other supporting staff’s critical roles in connecting the team’s plans to the patients whom we care for cannot be understated. They are the hands that heal and translate the blueprint into actual care at the bedside. It requires patience, tenderness, and selflessness that I question if I would be able to muster time and again. But somehow, the staff here seem to do it with smiles on their faces every day.

We live in an increasingly technology-driven era of medicine. Dr. Verghese from Stanford University coined the emergence of “iPatients,” who are dressed in “binary garments” on computer screens, their labs and radiographic images telling the doctors “when to feed or bleed.” There is an unmistakably growing gap between physicians and their patients as we rely more on numbers and algorithms. We learn to care for patients from afar, trapped into a computer-based workflow, diagnosing without seeing, prescribing without listening.

Amidst this transition, the nurses and other staff are the strongest human link that remains. Being aware of their work reminds us that healing does not take place on the computer or in the abstract.

Acknowledging them has, in turn, made me think more carefully before placing orders to consider the logistics. There are invisible ramifications to every decision we make. An order that takes me five seconds to place could keep someone else busy all night. For instance, physicians often prescribe laxatives after surgery to avoid constipation, but rushing the process and prescribing too much can just as easily result in incessant diarrhea, making it far more difficult for both the nurse and the patient. Taking an extra minute to consider the downstream effects of my decision can potentially save someone else several hours. Of course, certain tasks cannot be avoided, and I do not always succeed at helping the workflow. But with this insight, at the very least, I am always more grateful with every order I place that someone else has to carry out.

Not only in medicine, but in every aspect of our lives, there are countless individuals who help us carry out our plans, whose hard work make our jobs and lives seem easier, and make us feel more powerful and capable than we actually are. Their contributions may not always be obvious to us, but we rely on them nonetheless the way that we rely on gravity. When you find them, it will change the way you conceive of yourself in the greater picture, and influence your decisions to be more considerate of the whole.

It takes more than a click of a button to make amazing things happen, but with their help, perhaps you may get to feel that way from time to time.

Jason J. Han is a cardiothoracic surgery resident.

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