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Internal medicine physician and mom of 4

The machine

Healthcare is a machine.  A giant machine with a thousand parts.  Sometimes the machine is efficient, well maintained, oiled, and produces a product that will withstand the test of time.  Other times the machine is missing parts, hasn't been stroked by the loving hands of a caregiver in years, or churns out partial pieces of the final product.

I have spent years living in the machine, a small pixel in a big picture.  I try to be efficient and not be the rate limiting step.  I try to make sure the patient comes first do whatever possible to lessen the load a little or to brighten their day.  Even if every part to the machine is perfectly in tune and humming along just as planned, there is no escaping the process.

I have spent the better part of the last month in a different state with a close family member, much of it in one of the biggest healthcare machines around - the mothership of cancer-fighting known as MD Anderson.  These people hate cancer.  They really hate cancer.  They go to extreme lengths to fight against life-shortening malignancy at all cost.  They are hopeful.  There are survivor stories on every wall, and people in the waiting room who talk about how they've survived 2 years past their 6 week prognosis.

As machinery goes, the cancer mothership is a work of art.  I've enjoyed the shining beauty of streamlined processes like the "neutropenic pathway" which allows febrile chemo patients without immune systems to go home with antibiotics and very close followup instead of being hospitalized and exposed to much more virulent organisms (a process which, by the way, has been shown to lessen duration of antibiotics and side effects, avoid hospitalizations, and have no other different clinical outcomes than hospitalization).

But.  A machine is only as good as its parts.  Even a well built, well maintained machine can be brought to a screeching halt if one of the thousand parts doesn't show up for work (or worse yet, shows up but isn't present).  The scope of outcomes ranges from medical error (with or without devastating consequence) to inefficiency.  

The life-saving importance of every part performing at 100% capacity 100% of the time is rarely duplicated outside of medicine.  Yes, the airline industry, NASA, public transportation, protective services, and several other industries are examples (Honey will like to include automotive).  And I'm sure I'll hear of others in response to this post.  However, the overwhelming majority of industry tolerates a missing part or a skipped maintenance from time to time much better than the healthcare field. 

Quality improvement and safety surveillance have become integral parts of our world in healthcare, and hopefully further development in these areas will continue to improve outcomes and reduce medical error.  What I also hope for, however, is that quality improvement will lessen the burnout of the machine parts by enacting systems to relieve the constant stress that comes with being a healthcare cog.

It's been good to see the machine from the outside this month.  And even better to be exactly where I need to be to help a loved one.  This has been the longest I've been away from Big Girl and Baby Girl, but grandma is there and they are tolerating it much better than I am ;)

Go - maintain yourself, be present for patients, look for ways to improve quality, stay involved in the fight, and don't forget to hate cancer.
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robin mom
Taking the pulse of your medical practice -- in se...

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