> ‘I’m not starting a big meningioma at 4 p.m.,’ she declared, turning towards me. ‘I’ve got no childcare this evening.’
Without knowing what a "big meningioma" involves, I can only imagine it's something like doing a tricky, manual deployment on Friday afternoon. In that case no, this is a completely reasonable response. People have lives outside of work. Yes, "In the pre-modern NHS consultants never counted their hours – you just went on working until the work was done.", but that doesn't mean it's a good thing. In pre-modern factory days people of any age worked there whole day, 6-7 days a week. It doesn't mean that's a good idea to do it now.
> this is a completely reasonable response. People have lives outside of work.
For someone in IT, perhaps, but the professional expectations in medicine are starkly different (although they are admittedly growing more lax, to the chagrin of the old guard). In this particular case, the geriatric meningioma patient had already been cancelled on once, rescheduled with the promise of being the first procedure of the day, and then delayed to the end of the day because she tested positive for MRSA and they needed to do a decon of the OR after her procedure. You would seem to find it reasonable to reschedule her yet again, but neurosurgeons don't have much room in their schedules to play scheduling games with, and in general, patients aren't undergoing elective brain surgery for the fun of it: they need it now.
Perhaps the IT analogy is that neurosurgery is largely a hard real-time system: you must execute within a given time window or you fail.
> You would seem to find it reasonable to reschedule her yet again
No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem. This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand. What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no.
As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution)
> No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem.
The problem in this case was that the meningioma's MRSA positive culture results (from the first, cancelled procedure day) came back on the day of the rescheduled procedure, and that necessitated a schedule rearrangement (placing the meningioma at the end of the day) that the substitute anesthesiologist objected to. The author points out the absurdity of the situation re the MRSA culture when, if they had performed the procedure on the day originally planned, they would not have the culture results and so would not have done a post-op decontamination, but the rescheduling had forced the additional step. I think one does the best they can to budget for unexpected problems as had happened in this case, but in an overworked system, that cushion is among the first things to go.
> This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand.
Ideally, yes, one catches complications before they are a problem. Experience suggests complications still occur, and the only solution is to "be like water" and adapt.
> What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no.
Not for a physician. It is understandable for a physician to be ticked off, it's understandable for a physician to call in a favor and find someone to cover for them, but it is not understandable for them to say "no". The substitute anesthesiologist not only said no, but was apathetic to finding someone to cover for her. To that, I respond as I did before, the expectation from what I term the old guard of medicine is that your duty is to attend to your patients. Younger physicians, such as the anesthesiologist in question, would seem to share your perspectives on work scheduling, and the old guard say that the result is decreased quality of care.
> As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution)
That's a lot of handwaving. Keep in mind that in medicine, you can only kick the can down the road for so long, and that in this case, the patient's family had rattled legal sabers over the first cancellation. I suspect the possibility space is not as large as you think.
Irrelevant, the nature of your reason to refuse to work outside of scheduled hours is between you and your conscience. Be it a child, a dog, opera tickets, or Friday Night Magic - the rules have to be the same. Being a parent doesn't absolve you of responsibilities to patients nor does not being a parent increase your obligations to work additional hours.
Her disinterest in finding someone to cover is disappointing in a healthcare professional - but otherwise "I can't stay late tonight" is fine unless contractually you are on call.
> "I can't stay late tonight" is fine unless contractually you are on call.
This is potentially a reasonable point. If the surgeon can't make a compelling case to the on-call anesthetist that the case needs to be done, then the anesthetist present has a reasonable argument. That said, I've found that day shift staff may well stay late to handle a case they had already prepped for if that would prevent an up-prepped on-call from having to come in an hour later.
Bluntly, I don't care what they do so long as they do their job, and frankly, their personal lives are none of my business; they're a highly-educated mature adult capable of figuring it out just like their peers in the profession are somehow able to do. Some do a childcare service, some have nannies or babysitters, some have a stay-at-home partner… Surgeries run long all the time due to unforeseen complications, and I find it difficult to believe that this anesthesiologist didn't have a backup plan for those occasions. They may not have wanted to use it, and that is what I object to.
One of my parents is a physician and I didn't get to see them much when I was growing up (or even now); I intimately understand the point of view of those advocating for greater work-life balance in medicine. What I find lacking in the push for greater work-life balance is an acknowledgment that quality of care may be changing for the worse as a result.
> BTW, anyone shouting at anyone else is not even close to a solution
It may not be a solution you approve of, but I've witnessed plenty of cases where managers have effectively bullied their subordinates into doing work they otherwise wouldn't want to do.
Depends what you want to call a solution. Sure, if a manager bullies me into something I'll either do it or not. But I'm definitely raising this with his manager and/or looking for another position at that point. I'd call it a bad workaround for a current problem, not a solution.
Well, in that case the hospital should pay for extra childcare that evening (including possibly relocating the child to another child care location, which is no fun for the child either), and give them extra time off to have time together with their child at another time. Times have changed, people often live alone with their children (or their partner may be working), and you just don't leave a child alone.
When you got the meningioma, you better hope that your surgeon will work until the work is done, instead of delaying it because somebody's unable to find a babysitter.
Medicine was always about putting the patients' needs above your own, and I sure hope it stays that way for the foreseeable future.
I agree. It's a little frustrating to see so many argue so fervently of favor of work life balance literally at all costs.
Professionals in western society don't just magically find themselves in the position of regularly making life and death decisions. Those who do are there by choice. At least some tolerance of discomfort is both expected and required.
Well, when you pit "brain surgery" against "babysitter", it seems pretty clear cut. But imagine if you're that anesthesiologist, or one of a half dozen nurses required for the surgery, or whatever, and you've had to ask your parents to pick your kid up from school for the 12th time this semester because you won't be home before bedtime. Kids tend to not understand these kinds of things, parents know that, and they're rightly frustrated when their job unreasonably demands that their kids get short shrift.
That said, this sounds like a hospital procedure/scheduling fuck up. I don't think the anesthesiologist should be blamed at all, she stood up to unreasonable demands just as she should have. The hospital failed the staff and the patient here.
Would you be happy to be handled by an anesthesiologist who's in a hurry to get out as soon as possible, because they don't know what's happening with their children? Yeah, it's a bad choice, or a bad choice.
I'm not sure why you think "Medicine was always about putting the patients' needs above your own". Many hospital employees do. But I've never heard of medicine as a whole having that rule.
If you expect doctors to act like everyone's needs are above theirs, you'll end up with a current situation in the UK. Junior doctors who are overworked, hate the situation, government that wants to pay them even less for more hours (they've got patients to see, right?), and are more and more likely to move abroad - rather than just treat with respect like any other normal employee. And that's not even mentioning the dangerous situations created by tired doctors.
"the dangerous situations created by tired doctors."
These concerns are seriously overblown. Most errors from fatigue occurs on routine, non critical tasks, whereas I have never seen any evidence of a significant increase in critical errors.
A well-fed, rested doctors who abides by regulation is way more dangerous than a tired, hungry one who puts patients first.
"you'll end up with a current situation in the UK"
Poor remuneration is in no way related to great bedside skills, but is due to poor negotiation skills and State control.
> I have never seen any evidence of a significant increase in critical errors.
Google: study fatigue doctors. It's literally there on the first page.
> Poor remuneration is in no way related to great bedside skills
I'm not sure you're familiar with the issue in the UK. It's both about extra work and what counts as "unsocial hours". Considering the first to emigrate will be (were, actually) the doctors with better skills... yes, all skills are very related to how they're treated.
> all skills are very related to how they're treated.
Of course not, and that's my point.
Doctors are all paid the same in the UK, without any consideration for skills. Those who emigrate and get better pay, are paid better because they emigrate, and not because they do or do not put patients first.
> Besides, surgeons can no longer get away with such behaviour. I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment.
This is a good thing. Good lord, the ego of some professionals never fails to astound. Treating people like people in the workplace and not harassing them shouldn't be a difficult concept to come to terms with.
Many of the hospitals in Boston have surgeons so specialized that they're literally the only surgeon in the US that does their particular type of surgery.
For appendix removal, and trauma surgery, sure, your statement is correct. For brain surgery your statement is a bit ridiculous.
But the problem wasn't finding a surgeon. It was finding an anesthesiologist, who from the story's own description, isn't extra specialised.
Unless that person is on call, it sounds like someone screwed up the schedules by putting an anesthesiologist on a surgery that would take longer than they were still scheduled for.
They are a large growth in your brain or spinal cord. With this one, think softball sized. Though the link states that they may not be harmful if left to themselves, for a few days, I'd want it out asap. They can cause brain damage or paralysis in the spine. I know this as my PI had one and could only speak Spanish for a few days as his meningoma was pushing hard on his Broca's Area, the part responsible for a lot of speech.
That the lady was complaining of childcare is unacceptable and she should be reprimanded for it. Health care as a profession comes with costs that you know about when you sign up for the job. One of those is irregular hours. I can't imagine how she thought it was ok to put a person and their family through more costly time in a hospital over having her kid stay at daycare a little longer.
>> ‘I’m not starting a big meningioma at 4 p.m.,’ she declared, turning towards me. ‘I’ve got no childcare this evening.’
so with the scale of the money involved, the system can't deal with several hours of unscheduled in advance childcare? No intern around to send take care of it?
Ehhhhh, I don't really think anyone should be asked to work into the evening unannounced. Sure the stakes at hospitals are high, but that's all the more reason staff shouldn't be stressed, overworked, or distracted. The 40th time you ask your anesthesiologist to work late and put their child in night care from 5-9pm, they're gonna be pretty resentful, and rightly so. Do you want a resentful anesthesiologist? I sure don't.
Without knowing what a "big meningioma" involves, I can only imagine it's something like doing a tricky, manual deployment on Friday afternoon. In that case no, this is a completely reasonable response. People have lives outside of work. Yes, "In the pre-modern NHS consultants never counted their hours – you just went on working until the work was done.", but that doesn't mean it's a good thing. In pre-modern factory days people of any age worked there whole day, 6-7 days a week. It doesn't mean that's a good idea to do it now.