Tuesday, September 25, 2012

Decision Fatigue

Doctors taking care of patients who are hospitalized make a lot of decisions every day.

Here is a very conservative estimate for a common hospitalized patient on their first day of admission:

Each medication: Is it necessary? how much? how often? what route? hold parameters?
x10 meds = 50 decisions
Each lab result: Is this normal? If not, do we need to do anything? What should we do?
x15 lab results =45 decisions
General work up of hospital illness -should we treat? do we need more diagnostic tests? do we need a consult?
x3 med issues =9

1 patient = >100 decisions per day

x5 patients = >150 decisions per day

or if you're the senior resident or attending x20 patients = 1000 distinct decisions in a day!

Thus, after a call day, when a friend asks you where do you want to go for dinner -your response: anywhere, as long as you decide!

I think this decision fatigue is an under recognized but significant cause of fatigue, stress, and burn out in the hospital for residents. I know many of these decisions become much easier over the years, but they are still distinct decisions, for which you are accountable for in a court of law. Not so easy in my opinion.

Sunday, September 23, 2012

Did you know?

A piece of women's history and medical history...

The first woman accepted into medical school, Elizabeth Blackwell, was only accepted because her admission was put to a vote by the class at Geneva College of Medicine. As a joke, the class unanimously voted for her acceptance.

Turns out the joke was on them, as she went on to graduate 1st in her class in 1849.

Wednesday, September 5, 2012

Quote(s) of the Day

Elizabeth Warren was awesome tonight, so awesome she gets two quotes of the day

"No, Governor Romney, corporations are not people. People have hearts, they have kids, they get jobs, they get sick, they cry, they dance. They live, they love, and they die. And that matters. That matters because we don't run this country for corporations. We run it for people," -Elizabeth Warren, DNC 2012

“There is nobody in this country who got rich on his own,” Warren told them. “Nobody. You built a factory out there? Good for you. But I want to be clear: You moved your goods to market on the roads the rest of us paid for; you hired workers the rest of us paid to educate; you were safe in your factory because of police forces and fire forces that the rest of us paid for.” 

The second quote encapsulates 100% what it means to be a democrat. Perfectly put. Thank you future Senator Warren!