The Ripple Effect

Yesterday, I started my morning with a very angry email from a patient’s son.  I won’t go into the details due to patient privacy, but they don’t matter.  He had a reason to be upset, but the reality is that I hadn’t truly done anything out of the norm of standard patient care to warrant that type of reaction.

When I read it, and starting telling my colleague about it, I lost it.  I start crying.  We were just starting our morning, and our first patients were getting roomed.  But my colleague knew I was not in a good state to see patients, so she called over our lead (our mini-chief in our location), and they redistributed my patients for part of the morning to other doctors’ schedules.

For that part of the morning, and honestly all day, I was extra emotional.  As I would start to talk about what happened to other colleagues who were concerned, I would start crying again.

On a logical level, I know this email wasn’t something I should have gotten this upset over.  My reaction to it was a reflection of my state of mind.  I’ve been chronically overworked, and when I feel like I’ve been working so hard, sincerely doing the best I can for my patients, and then the thanks I get is this angry email?  It’s completely demoralizing.  I was already mentally and physically tired.  And that’s why it broke me.

The chief of my department happened to be at my office location in the afternoon and came to speak with me.  I appreciate that she’s aware that our current workload for those of us in the office only full-time is not sustainable.  She is trying to make changes within her power.  But she’s limited by the fact that we’ve been short doctors for the last several years, and it’s not that easy to hire good quality doctors that quickly.  She’s also limited by the powers that be- those above her making decisions that affect what we’re all mandated to do, such as how many patients we see per day.

I told her about this article I came across recently in the New York Times:

It was written several years ago, but they recently re-posted it in their daily email.  It’s still just as relevant today.  It talks about what employees need to feel happy and engaged at work.  Value- feeling cared for by your supervisor.  Focus- being able to focus on one task at a time.  Purpose- deriving meaning and significance from one’s work.  Renewal- taking a break every 90 minutes.  When these needs are met- surprise, surprise- employees are happier and more productive.

I found the renewal part interesting because I definitely don’t get breaks every 90 minutes.  What tends to happen is that I keep working throughout the day.  Even during the lunch hour, if we don’t have a meeting, I’m eating and catching up on results and emails from patients.  Apparently in the end, the constant working makes me less efficient than if I completely stopped working to take a break.

So what I really need during my office day is a forced meditation break in the middle of my morning and again in the afternoon of seeing patients.  It’s kind of like when I used to get breast milk pumping time.  Except I usually spent that time concurrently typing and doing work.  It would take a significant cultural shift, and probably a monetary incentive, to not only give us the time to spend 10 minutes on a meditation app or the like, but to get us to actually do it.  It’s a hard habit to break, when we’re used to continuing to work, work, work to get the job done.

The main reason I wanted to write about the nasty email I received is that there is more I wish I could say to the patient’s son who sent me that email.  I did write him back to courteously respond to his concerns and explain things from my perspective.  What I really wanted to say to him was:

Dear [Patient’s Son],

I understand that you are upset about what happened with your mother, resulting in the email you sent me.  I want you to know what happened after that email was sent.  I read the email, and I started crying.  I was so upset that I could not see the patients I was scheduled to see that morning.  Other doctors had those patients added to their already busy schedules.  My husband was very worried about me after I texted him that I had a breakdown at work.

It’s natural to lash out with angry words and call me negligent when you feel the way you do.  I’ve felt that way, too.  Next time, I hope you take a step back to think about how those words might affect others.  Those words affected not only the intended recipient, but also her patients, her colleagues, and her family.  This same effect can occur whether you are speaking to a doctor or a telemarketer.

A more productive way to communicate would have been to explain why you were upset, and then to ask more.  “Doctor, why did you respond the way you did?  What was your thought process?”  Yes, doctors make mistakes and sometimes they are big ones.  But most likely, there is more to the story.  Finding out more before lashing out fosters learning on both ends, rather than angering and distancing both sides.  I hope you keep this in mind the next time you feel this way.

Sincerely,

Me