Residency is the time in a physician’s career that starts with wide-eyed bewilderment and rapidly the realization sets in (among many others) that there is no time for that bewilderment.
First realization: The things I learned in medical school do not apply to being a functional doctor/resident and there are patients (children and parents in my case) relying on me to be said functional doctor.
Second realization: I have X number of years to learn everything these patients expect me to already know, the clock started before orientation, and that clock is entirely unforgiving.
Third realization: It’s 4 o’clock and I forgot to eat lunch.
Fourth realization: I also forgot to page that one consultant again and now it’s too late for a patient to get their imaging without figuring out a way to bake cookies and bribe some technician to stay late.
These all happen in your first week as an intern. The speed at which these thoughts occur increases progressively at a rate proportional to how fast your morning cup of coffee gets forgotten and cools off (needless to say, I’ve learned to enjoy a cup of lukewarm coffee in about 3 gulps). It was one of the many adaptive qualities I adopted during my Pediatric residency, and it all felt entirely normal to me.
To be honest, I fed on the adrenaline rush and intensity. I became one with the system: I knew which fax machines worked and which were distractors; I knew which workstations had two phones next to each other so that I could actively answer one page while not taking up a phone line and accidentally miss a consultant call-back on the other; I wrote every note in a word document on one of the VMware computers because I knew if my EMR shut down and I lost a note, word would save a back-up; I kept protein bars on me at all times as peace offerings to the “hangry” residents I was instructed to page over and over with updates or questions.
Let me pause and direct your attention to the fact that “fax,” “corded phones,” and “pager” were all just used as an entirely normal part of my daily life. It was the only option we had.
Everywhere outside the walls of hospitals, we live in an age of more, faster, and better. It’s expected, not desired. Expected by our superiors, by our patients, and by ourselves. If and when we fail to deliver the impossible, we feel like it is us that has failed – not the system.
Doctors are a breed passionate about improving, we analyze and explore what is holding us back. In researching the root cause of dissatisfaction, “slow care” continually makes the list, but what is the rate limiting factors for the success of our efficiency? It’s not how fast our neurons are firing; rather, if you ask healthcare providers, the answer you’re most likely to get is…technology.
But how can that be? Technology is responsible for enabling us to communicate with anyone anywhere. It allows us to send documents magically to another facility without having a courier-pigeon deliver it. It’s how we are able to read typed notes instead of having to decipher physician-hieroglyphics. It’s everything that has made medicine easier for residents in an evolving world, right?
We have adapted to keep up with the light-speed of the world around us everywhere…that is until we step into the hospital. All of a sudden, we are given the aforementioned equipment and processes that stopped evolving 20 years ago. Most residents have never seen or touched a pager until they joined the medical force. Now, rather than using the instant communication mechanisms that are natural to us, we are forced to walk and think in slow-motion: using corded telephones, numeric (alphanumeric if you’re lucky) pagers, and fax machines.
Over the past 3 years, I was in the unique position to see two sides of my life within a medical environment. I saw myself working with the technology of the 1990s, where I proudly overcame the impossible and also found enough workarounds to find time for meals and bathroom breaks (usually).
Halfway through my residency, I saw the exponential difference that the incorporation of one piece of modern technology can make.
Secure texting utilizing TigerText (now TigerConnect) was implemented and my inside-the-hospital communication started to catch up with my outside-the-hospital life. My efficiency not only skyrocketed but I noticed something way more incredible…
Everyone was less grumpy.
Busy surgical residents who were used to being paged repeatedly now were able to see and respond to a text with non-urgent updates. I could walk away from my station to see a patient or complete a different task without having the looming feeling that I was going to miss my one chance to talk to a specialist. Communication was faster, easier, and more concise. When we did talk to each other in person or on the phone, it frequently ended with “no problem, just text me,” which seemed to be met by a pause and smile every time. The relief felt by sending a simple text allowed residents to be more willing to work together and seemed to make us all more efficient across the board.
There will always be more to improve in medicine. There will always be new ways to create stronger, faster, more efficient residents. But the thing that was the most striking to me wasn’t just how much more efficient I became after the implementation of a secure texting system in the hospital – it was how much stress it seemed to relieve among providers and residents. In this world of rampant stress, anxiety, and depression, we should all be working together to heal our patients and each other. Technology shouldn’t be our rate limiting step. It should take its place as a mechanism of making life easier, just as it does everywhere else in the world.