Shirah Vollmer MD

The Musings of Dr. Vollmer

Work Ethic

Posted by Dr. Vollmer on April 8, 2015

Another rant about how the world of medicine has changed. In my era, we saw inpatients, which meant that we saw the same patient every day. That patient expected Shirah to show up, and not the “doctor.” Some patients would track when I was on call (sleeping in the hospital, resulting in a 36 hour shift) and they would have the nurses page me in the wee hours, because they wanted to talk to ME, not the doctor on call. I would have seen that patient hours early, during “business hours” but as we developed a bond, he began to see how talking to me relieved his anxiety, as we developed a trust which grew out of spending many daylight and nighttime hours together. Seeing these patients was more than my job, it felt crucial to the well-being of these hospitalized patients. I, like my colleagues at the time, would never think of “leaving early” or “coming late” as we understood that specific patients were counting on us to be there. It was as much my personal integrity, as it was my professional duty to show up and work my grueling hours. Fast forward thirty years and inpatient psychiatry has dwindled, making the Resident’s experience, mostly outpatient. As a result, the Psychiatry Resident never sees the same patient every day, nor does he/she see them every week. Patients are shuffled like cards and they may or may not see the same doctor, at a frequency of once a month or longer. Consequently, Psychiatry Residents do not have the same work ethic, as it is not as critical that they be on time, or show up for a particular patient. The environment changed, and so did the working style. I do not blame the Residents, as I would be just like them, if I were working in today’s environment. Patients depending on you is different than a clinic depending on you. The problem is not that millennials were raised with entitlement, although that may also be at play. Rather, the problem is that the work is no longer personal. If you change the game, then you change both the people who want to play, and how the players approach the interaction. Duh?

9 Responses to “Work Ethic”

  1. Ashana M said

    I think our culture has become more indulgent as well. It’s already extremely indulgent and I think that tendency has steadily increased. “Take care of yourself” is the byword.

  2. Yes, that indulgence, or entitlement, as I call it, is prevalent, but with the increase of automation,at least in medicine, there is less of a compelling need to “show up” for people. Thanks.

    • Ashana M said

      Indulgence has to do with whether a society allows and approves of gratifying personal needs and desires–people in indulgent societies don’t feel guilty over enjoying life and pursuing leisure activities, but in restrained society it’s just not comfortable. I don’t think it’s quite the same thing as entitlement, which seems more like a sense of having more rights than other people or the right to have rewards that aren’t earned. Indulgent people go out for a coffee from time to time. An entitled person thinks the coffee fund ought to be provided to him or her. My sense of people being increasingly indulgent seems a result of my parents’ generation’s disillusionment with the “good life” as an outcome of hard work. It became a “rat race” and not a ticket to happiness, and it started to seem preferable just to enjoy what you have instead of always working for more. That is my perception of millennials anyway, which may not be accurate. They seem much less selfish–more indulgent, but less acquisitive–than my generation.

  3. Shelly said

    You say that inpatient psychiatry has dwindled. Does that mean that a need for inpatient treatment doesn’t exist anymore? Who treats patients in the hospital? Are there no more residents who treat patients who are hospitalized? I realize that hospitalizations used to be weeks and now are only days long. I also can’t decide if you are lamenting this change or are wishing for the “good ol’ days?” Can it really be true that patients “got better” at a much quicker rate such that they no longer needed long hospitalizations, or that hospitals found that they were losing money and therefore “turned them lose” faster?

    • That is a very good question Shelly. The current state of inpatient psychiatry, as you say, is that 90% of patients stay for less than one week. This is, in part, an unintended consequence of our medications. In the old days, psychotherapy was done, along with some medications, to help people heal in the hospital. With our atypical antipsychotics and newer antidepressants, there is a sense that once someone is medicated they are free to continue treatment as an outpatient which means they are seen less intensely. For some patients, this works well, as it helps them resume their lives, but for some people, they need a re-boot and so they need time to transition to wellness. Insurance companies do have a lot of influence here, so as you say, we cannot deny that. I am lamenting the loss of the doctor patient relationship, and noting that one consequence to this transition is that without personal relationships with patients, then the work ethic diminishes. Thanks.

  4. Merna said

    What a sad situation, Shirah! It’s all about economics, isn’t it?

    Out in the real world, clinics have operated that way for decades. The patient arrives for an appointment and a doctor shows up. That’s exactly why we’ve chosen to see a psychiatrist outside of our HMO, for consistency and our choice of practitioner.

    • Yes, essentially, The adage of “follow the money” does apply here. Yes, some people will choose more personalized service, but the majority of the population will not know the difference and go to the default system of anonymous care. This is both sad for patients and for providers. Thanks.

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