My life feels increasingly complex. Despite feeling completely swamped, I never seem to get much done. My husband and I discuss those days before we had kids and wonder what it was that we did. I can remember some things – slow cooking, planning a menu, even. I miss all that stuff. Like kids toys, complexity expands to fill the available space.
As I work through this process, I have been following the ideas of others, based around non-medical work. There is clutter I can cut out of my life, just like anyone else. Medical and paramedical work brings some extra challenges to simplication – how do you simplify when you have to keep up with everything?
As I think more about it, medical life parallels the rest of society. We used to live simpler lives, with most of our impact on the people in our immediate neighbourhood. Society used to be about individuals interacting together and affecting each other. The local shop keeper changed what stock they kept to cater to the 20 families that were purchasing from it. Barter between neighbours was a form of commerce, and children grew up knowing others in their street and being cared for by neighbourhood parents. The information boom made our choices more informed, but more difficult. And we started to impact people in a much larger geographical area.
Originally, Doctors dealt with their community and were judged by their community. If they had a low incidence of Dengue Fever, then they knew very little about it. Their training was very broad, but through experience, they learnt a lot about their relevant demographic. The individual practitioner based their decisions on the thousands of patients they had personally seen. If something rare turned up, they might flounder, but their patients could also recognize that it was an extreme situation. Most patient encounters had no impact beyond a 100 km radius. Maybe we should call this “slow medicine” in the style of “slow food.”
Today, everything is a lot faster. We may see less patients, but we do more to them, and use more information to do so. We are not only expected to keep up with the fates of patients across the world, but even conditions outside our own field of expertise. Instead of knowing lots of common things well, we focus on an increasingly smaller sliver of health. Conditions that could once only be diagnosed at autopsy can now be be discovered in the sick patient by using tests that are based more around electronic algorithms than doctor skill. Our work is increasingly information driven rather than relationship driven. So we have increased pressure to stay in touch, keep up, know everything.
Medical information is changing rapidly. Even 12 years ago when I was in Medical school it was sufficient to buy textbooks, and use them as a reference. And qualified doctors would sit down with their pile of subscribed journals and read them up to date once a month or so. Now I subscribe to electronic table of content alerting, to know the new information quickly. New treatments are rapidly adopted, so that once long term side effects are understood, the treatment burden is huge. At my exam, I am expected to know current best practice, and can’t afford to base my decisions on a textbook that may be years out of date.
So medicine is complicated. So what?
Medical science makes itself complicated. Patients via inadequate health systems create pressure. We all know that we could choose to work 18 hours a day, and we would easily find patients to see. So in order to stay still, we need to actively reduce the complexity. Obviously we can’t ignore reference information. But perhaps we can change the way we behave as physicians. We can set limits on our own skills, expectations and obligations.
I am not an expert at simplicity. I hardly know where I will start to sort this out. I do know there is a difference in the way people practice. I have registrar friends who feel it is important to stay later than their bosses, just for the sake of it. Other colleagues seem to believe there is a competition to start earlier and leave later. But I recently had a conversation with a colorectal surgeon who helped some of his six children build two billy-carts for a derby, and race them one weekend. I suspect he has a different relationship with his family than the others.
I have an opportunity. I have not worked clinically for some years. I have not studied clinical medicine for most of that time. So I am allowed to start again. I can decide what limits I want to have. I can choose to do whatever is within my influence to practice “slow medicine.” I dream that one day I will be a surgeon who is able to focus single-mindedly on the task at hand. I am not aiming to not be busy, but I choose to keep focus, stay healthy and not lose myself.
Leave a Reply