Doing What We Don’t Want to Do

Unhappy DoctorThe bottom line here…is that I am increasingly devoting more time to the generation and recording of data and less time to the educational substance of what the data is supposed to measure. Think of it as a man who develops ever more elaborate schemes for counting his money, even as he forfeits more and more of his time for earning the money he counts.
—Garrett Keizer, Getting Schooled: The Reeducation of an American Teacher

Lately I have been reading a lot about the growing unhappiness doctors are feeling with their profession. Increasing numbers of physicians are reporting a loss of professional ideals, perceived loss of status and respect in the society at large, low morale among their colleagues, and a decline in the sense of the nobility and core purpose of the profession. Many feel like pawns in the money-making business of health care delivery, resulting in an increasing number of them saying they would discourage family members or friends from becoming physicians. As one doctor put it, “American doctors are suffering from a collective malaise. We strove, made sacrifices—and for what? For many of us, the job has become only that – a job.”

Among the biggest concerns voiced were having less time to spend with patients (the one part of the profession doctors routinely indicate is the most satisfying part of their jobs), salaries that have not kept pace, skyrocketing malpractice insurance premiums, and the paperwork—most doctors attest to spending at least an hour each day on insurance company claim forms.

With the growth, even requirement, of keeping electronic medical records, doctors must deal with a costly as well as time consuming activity. Some report spending almost ninety minutes a day entering data, time some claim would be better spent calling patients or keeping up to do date on medical literature. What’s more, insurance companies are increasingly requiring pre-authorizations for prescriptions or treatments, adding to the amount of time—whether waiting on hold or filling out forms—spent away from what these professionals most find meaningful in their work. As another doctor put it, “The practice of medicine in the current environment is unsustainable” due to the “multiple bureaucratic distractions in my day (that) consume so much time.”

I suspect that physicians are not alone in their concern about the quality and direction of their profession. Other professions—law, journalism, even the clergy—might well report lower levels of satisfaction with much of the work required, particularly the degree to which much of what they must do, day after day, feels like an all-consuming diversion from the reasons why they entered the profession in the first place. Teachers across the country have certainly spoken often about the perceived decline in the respect in which they are held by society—including in the eyes of many parents. So, too, as Garrett Keizer reported in his recently-published book which chronicles his return to teaching after many years, in rural Vermont (see above), many contemporary teachers would echo the concerns about data, in that the system rewards the constant attention to data entry as opposed to the relationship between student and teacher that the data is supposed to support.

I would venture to say that all of us, to some degree, deal in workplace diversions that seem to pull us away from the things we most love about our work, indeed the root motivations for why we initially chose such a vocation. The blame cannot be assigned to one thing—such as the entering of data, which in some cases actually benefits the work that professionals feel is most important—but to the ever-expanding and increasingly complicated role of virtually any job today. As we continue along in our work roles, it seems a given that our responsibilities increase while little is done to cut back in other areas. All of this leaves many with not only a sense of fatigue but an existential concern over the direction of their respective profession.

Last week, when I was visiting a school, a teacher told me about something that had occurred the previous day. A group of students who had just graduated from the school in the spring and were now among the last students to head off to college showed up at her door unannounced—as is usually the case! Their presence at her door was a tribute to the regard they had for her teaching and influence in their lives. All of them were eager to talk, but the teacher felt the inevitable pull of all of the work that she had waiting on her desk and computer. “Why do they (graduates) always show up at my office when I am so busy with other things?” she asked.

To some degree, all of us are going to find ourselves engaged in activities that seem like a diversion from our core satisfactions and reasons for why we chose the profession. It is good to be able to identify just what those diversions are, and how much time they seem to consume in our work day. Inevitably, we will feel the pull that the teacher mentioned above will feel—such as students who need our attention seemingly taking us away from all of the routine work that we must do. It is something with which we must, to some degree, make peace. But the pull we feel also tells us something about who we are and what we value. Which means that we cannot lose sight of our central mission and joy; the inevitable and necessary diversions make it all the more important for us to be, in the words of one physician, “identifying what is important to you, what you believe in, and what you will fight for.”

I asked the teacher what she did when the graduates arrived at her office, wondering if she sat and visited with them or apologized for how busy she was, asking them to come back another time. “I took the high road,” she responded, “I set the work aside and talked with them for a good amount of time, and I am so glad I did.” Good for her, I thought!