I have been reading a lot recently about simplicity. I am in the final phase of my postgraduate degree, and it is leading me to critical reflection. I have young kids. I am writing a thesis, while finishing experiments. I am thinking about surgical study again with my fellowship exam in a year or so. Despite feeling completely swamped, I never seem to get much done. My life feels increasingly complex. 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. I have to simplify.
Non-medical life seems easy. There is life-clutter there that I can trash. But medical work seems too complicated to simplify. Everything is important.
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 who were customers. 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 them. 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 common illnesses. 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 understand that exceptional things happen. 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 (in the form of “evidence”), 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 referecne. And I remember my lecturers telling stories based around reading through a whole pile of out of date journal subscriptions once every few months. 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 expectations and 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 obviously am not an expert at simplicity. I don’t even where most people would start. I hardly know where I will start. 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 2 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.
Note: I have been thinking about this a lot recently, and I am going to be writing a series of posts on simplicity in medicine at my other blog, AppleQuack. As a part of that, I would like to share some case studies. If you are interested in being interviewed on tactics for achieving simplicity in your field of medicine or allied health, please contact me at cris at drcris dot net.
Photo credit: dawnzy58 via Flickr
great post! look forward to more of such posts.
Hmmmmm, that early paragraph about knowing people in your street and caring for other kids sounds a little like where we live. Not a bad place to be 🙂
@AlliW: That’s why I plan to move regional at some stage – certainly simplifies life, and lets you focus on the people you work with/for. However, in my field it also increases the time invasion – you are more likely to be on 24 hour call as you become less anonymous.
Yes, the Doc situation up here is not that great. Hours are through the roof, A&E is open limited hours to help docs cope and the public miss out because there aren’t enough to cover! You also have reduced options for a GP as you get to know them more personally!