Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
More on work hours and scut work
28 Oct2009
A loyal readers writes:
“Disappointing. I would not argue with you that rigor is essential in
training. But to argue that scut work is essential is silly. “Scut
work and mindless b.s.”, as the blogger you cite calls it, gets in the
way of actual learning and is morale defeating. Why demand
inefficiency and educational waste?To use your Tiger Woods analogy, it is like saying Tiger can become a
better golfer by spending a few hours a day washing his own golf
balls. I call b.s. on that, and I look down on attendings who suggest
I can be a better physician by doing the medical equivalents of
golf-ball washing. It is, thank God, not a big problem at my
program.”
The problem here is in the definition of scut work. Certainly, scut has decreased over the past 30 years. During my internship, we drew all the bloods and often carried them to the lab. We started the IVs. We read our own gram stains and did the staining ourselves. We looked at the urine.
The gram stains were useful scut – and I believe we lost something in education when we were told (by the lab police) that we could no longer do that. Looking at urine was worthwhile.
But I would argue we have worse scut today – the irrational note. We make housestaff (and attendings) write long notes for billing purposes. This is scut work of the worst type. I would rather draw blood and start IVs than write billing driven notes. At least when drawing blood I am in the patient’s room.
That being said, the reader’s point is well taken.
Related posts:
- How should we balance learning with work hours?
- The degradation of physician’s notes
- 17 days at the VA – Day 3
- What is scutwork?
- 17 days at the VA – day 17
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- In: Medical Rants
5 Responses to More on work hours and scut work
Ed Whitney
October 28th, 2009 at 1:56 pm
Looking at the urine, doing the Wright’s stain and looking at the peripheral blood smear, and doing the Gram stain of the sputum in the lab on the floor–these were all part of the basic patient workup, no different from looking at the eye grounds or listening to the lungs. If the “lab police” are now prohibiting these activities, something is very wrong indeed. Rarely, you might see that the supernatant was a bit cloudy after spinning a hematocrit, and pick up a lipid disorder that you had not suspected. Walking back and forth from radiology to pick up old films was a waste of time and it is just as well that it is no longer done.
But if they start making housestaff fill out CPT codes, the time for revolution will have come.
Kendra
October 28th, 2009 at 2:38 pm
I’ve executed every type of scutwork possible. I’ve done everything from drawing blood to chasing down lab results to photocopying to getting coffee for a resident. There were times when I felt overwhelmed by the amount of scutwork asked of me. However, in retrospect, I think about 90% of the scutwork that I had to do helped me along my journey in some way. Drawing blood and changing bedpans gave me skills that I need to have if and when a nurse is not available. Photocopying various forms taught me how the clerical side of medicine works. And some of the scutwork merely taught me humility. Sometimes our “education” is not merely learning the mechanism of diseases or which drug to chose, but learning about how the hospital runs and appreciating how all the various hospital employees function together to care for a patient. I’m glad to have done my fair share of scutwork. I happen to think it will make me a better doctor. Just my three cents.
More on work hours and scut work golf bar
October 28th, 2009 at 2:47 pm
[...] See the rest here: More on work hours and scut work [...]
Stalwart Hospitalist
October 28th, 2009 at 10:59 pm
The “golf ball washing” analogy extension only works if we stipulate that resident physicians are as good at medicine as Tiger is at golf.
To torture the analogy further, I would argue that a “golfer in training” needs to at least know that a clean ball travels farther and straighter.
PK
October 30th, 2009 at 3:42 pm
I have actually been a bit disappointed at the lack of procedural skills I have been exposed to. The only IV that I have started in my 4 years is the one that I started on my brother (who is an RN and wanted to teach me).
I’m actively trying to pick up a few of these menial procedures, but at this point I have done more CVLs than IVs or blood draws combined. I realize that in the real world I will likely not have to perform these tasks, but they are still things I would like to be able to do.