Don't Blame the Canary

Don’t blame the canary, the coal mine is brutal.

This week has been rough. Orthopaedic surgeons lost another great one to suicide. As we virtually support each other through our loss, we compare notes.

Our profession is brutal. We all love what we signed up to do, take care of people who break bones and injure arms and legs and knees and shoulders and hands. We help people with and without doing surgery. And sometimes the part about not recommending surgery can be the hardest.

Most physician specialties have gravitated toward a shift model that creates availability for patients that need urgent and emergent care any time of day or night. The medical and pediatric specialties have specialists called “hospitalists” who are perched to care for anyone who needs care in the hospital. Emergency room physicians and anesthesiologists and radiologists work in shifts to cover all hours of the day and night, relieving one another with predictability.

There are few fields that continue to function in the antiquated way that orthopaedists function. We work long “business” hours. Then we cover “call” after hours. When we are awake all night, most of us continue to work the next day. We do not get relieved by the next shift. We protect our residents and students from this absurd way of life, but not ourselves.

The administrative burden of patient care in 2020 for surgeons is tremendous. We signed up to work hard: to meet patients where they need to be met. To diagnose, to treat, to operate. But the work surrounding that care that we love grows each year. Administrators have been added to the healthcare workforce to meet these requests, and they now oftentimes outnumber physicians.

As healthcare in 2020 looks to emulate the service industry, administrators often expect physicians to function like employees at Amazon, Marriott, and Starbucks. When patients lead their care with the expectation that they are a “customer who is always right,” their care can suffer. Sometimes the correct thing to do is not to order an expensive test or do unnecessary surgery.

Physicians find themselves caught in a web of pathological altruism. The system functions on the back of the professionalism of the doctors, and this professionalism is taken advantage of. Physicians are expected to “please their customer” or make the patient happy at all costs. And giving too much can cause harm.

Ultimately, the responsibility for medical errors lies with the physician, who is at the helm of the team. The policies and procedures and systems are often not physician-led. Thus another conundrum for the surgeon.

Pressure to work quickly in the operating room and in clinic amps up more each year. More documentation is expected from the regulators. As reimbursement for each patient visit and surgery decreases, doctors need to see more patients to make ends meet. Resources to support care in the operating room, such as equipment and staff, are dwindling.

Then there is COVID. COVID reintroduced gratitude and respect for physicians and clinicians. But it has made our jobs more dangerous. And many orthopaedists have not been able to do elective surgery. As income has dwindled, some have even had to close their practices.

This is not about lack of resilience in the orthopaedist we lost. This is about a system that has failed our patients and our doctors. I continue to call us to action. The coal mine is toxic, and it is not the canary’s fault.