AMAV VICDOC SUMMER 2023 - Magazine - Page 79
A
utonomy is something we give to our
patients. That’s the bedrock of medical
ethics — respect for patient autonomy
over their health and their choice of
treatment. As doctors we make diagnosis and
we offer our recommendations, but the ultimate
decision on treatment is in the hands of our
patients (except in very few select situations
where the patient is unable to do so).
Let’s put the mirror up to ourselves now.
Do we offer ourselves autonomy? Are we
given autonomy in our day to day practice
as clinicians? Does your department head or
supervisor of training allow you some autonomy
in your work?
All through medical school and surgical
training, I have been trained to think in a certain
way and act in a certain way. All of our training
is about principles, rules, regulations, protocols,
policies, and they’re
all good — to a certain dogmatic degree —
for the sake of our patients. As a surgical trainee
years ago, I felt my life ruled by my pager and oncall roster. I had loss of autonomy. I did not see
my family much due to relentless call backs. I lost
my social network due to frequent relocations
through training. I lost my hobbies as they are
displaced by the time demands of training, work
and study. This rigorous training is necessary
to a degree, but is also erosive to the individual
personal autonomy.
As consultants, many of us have better control
over our days, but we are also merely cogs in
the wheels of the complex healthcare system
with many jurisdictions and administrators
determining our day to day work. As we spend
our days chained to computers on wheels clickclick-clicking the EMR, the song “I want to break
free” by Queen sometimes echoes in our heads,
or maybe just in my head (sorry if you are not
from that awesome generation).
Autonomy is not absolute freedom. Autonomy
is the freedom to decide what is good for us.
Yes, there is a sprinkle of selfishness in there if
autonomy is taken to an extreme and intrude
on others’ autonomy. We are clinicians and of
course we have to abide by rules and principles
when we treat patients and work in teams. But
perhaps the lack of freedom to do what we really
want to do because of the numerous mundane
non-clinical work displacing the essentials is
what is causing personal distress in us. Multiple
studies have shown that bureaucracy and nonclinical tasks are the things that cause emotional
distress and burnout in many of us.
How much autonomy is enough autonomy for
us as doctors? As it turns out, there is a number.
And that number is 20%. From Dr Tait Shanafelt
[1]: Evidence suggests that doctors who spend
at least 20% of their time focused on the
dimension of work they find most meaningful are
at dramatically lower risk for burnout. Although
each 1% reduction below this threshold increases
the risk of burnout, there is a ceiling effect to
this benefit at 20% (eg, spending 50% of your
time in the most meaningful area is associated
with similar rates of burnout as 20%). This
suggests that doctors will spend 80% of their
time doing what leadership needs them to do
provided that they are spending at least 20%
of their time in the professional activity that
motivates them. This activity could involve caring
for specific types of patients (eg, immigrant
health) or patients with a given health condition
(eg, becoming a disease expert) or activities
such as patient education, quality improvement
work, community outreach, mentorship, teaching
students/residents, or leadership/administration.”
Interestingly, high performance organisations
such as Google and Apple recognise this and
apply this principle of allowing staff members to
have a degree of flexibility in their work. What
about us? We trained to be clinicians and that
privilege comes with certain responsibilities such
as teaching, research, leadership, administration,
and other non-clinical duties. Let’s be honest,
some of us are better at one thing than another,
and in reality that’s probably because some of
us prefer one thing over the other and find one
particular thing to be more meaningful than
another. What if we gave each other the gift of
autonomy and allow each other some freedom
within the boundaries of our responsibilities
to do work which we uniquely find most
meaningful. Just 20%! How will that affect
our job satisfaction, job effectiveness
and patient care?
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