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    The myth of the ideal day for physicians

    2017 Physician Writing Contest: Honorable Mention

    As the crow flies, their rooms in our rural hospital were less than 100 feet from each other, but their experiences couldn’t be more divergent.


    Further reading: If you operate a medical practice, you should be outsourcing


    In our labor unit, Emma was just hours from entering the world. Her parents, Valerie and Aaron, had diligently attended each prenatal visit and eagerly anticipated her arrival. Valerie’s labor was progressing smoothly, but it was clear that the delivery would drag on late into the evening. 

    In the next hallway, our critical care unit, Arthur was preparing to enter eternity. For several years, his COPD had been inexorably advancing, requiring maximal medical therapy, continual oxygen and increasingly frequent hospitalizations. His family had repeatedly rebuffed discussions of end-of-life or hospice care, and though they agreed to honor Arthur’s clear DNR directive, they insisted we continue all therapies short of intubation. 

    Then he presented in severe respiratory failure. Positive pressure ventilation, which had rescued him during several previous hospital admissions, was having only a marginal impact on his respiratory failure this time. His respiratory distress was worsening and agitation was escalating.

    I was up most of the night adjusting his ventilation, carefully titrating his medications, trying to bring him some level of comfort without abruptly eliminating his respiratory drive. I met repeatedly with the family for lengthy discussions, trying to help them understand that Arthur would not rally this time and they needed to prepare themselves for his imminent death.

    One family about to welcome a child. Another family unable to accept their beloved patriarch was not going to survive this hospitalization. And me, their attending physician, deprived of sleep and hungry for an evening with my family. It was a typical day.


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    I know what my ideal day looks like. I awake refreshed before dawn, read and write for inspiration, pray and meditate, play the piano, run a few miles as the sun rises and have an engaging discussion with my family over breakfast. At work, I attend the deliveries of all my obstetric patients (during daytime hours of course.)

    I stay on time in clinic while keeping up with charting, phone messages and urgent care needs. I meet productivity, clinical quality and government reporting goals, while providing meaningful clinical and informatics leadership for our practice and our local hospital. I return home with adequate energy reserves, eat dinner with my family and am able to be fully present as we participate in our evening activities together. 

    In over a dozen years of practice, how many days have followed this idyllic pattern? Precisely zero. But although individual days have their fair share of perceived disruptions, frustrations and disappointments, I have managed to maintain a sustainable degree of overall work-life balance following a few basic principles I return to over and over again. 

    Next: "I accept I'll never have an ideal day"


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