Friday, June 29, 2007

Off Your Desk

I will be covering on a Continuing Care Unit the second week of July. We are not allowed to say “Long-term unit” anymore because somehow it sounds worse to somebody than “continuing care.” This sort of intervention is very typical of government work: people who get paid more than I do spent a lot of time in meetings coming up with this.

I have worked acute psychiatric admissions for most of my 29 years here. There is a wide abyss between admission attitudes and long-term attitudes. I don’t need to go into detail about the specifics of psychiatric hospitals; the point I wish to make is general. Coverage on non-admission units is so easy as to be maddening. There is less than half the work, though there is more time spent in meetings. People are unable to get to the point in conversation and burden you with extraneous information. *

While there are some good reasons for this – upstairs staff spend much more time talking with very sick patients in an effort ot form a bond and encourage them – the main difference I see is that they do not know how to get things off their desk. There are a variety of applications that take about two hours each in this field: Medicaid, housing, guardianship, nursing home, and a half-dozen less common. Whenever I cover, there will be a dozen of these things in various folders on or in the desk. Some are partially completed… others have only a name and a few notes… a third group are complete except for one important piece.

Organizing your work like this is about the best way I can think of to get discouraged and feel it is all just too much. Literal piles of work accuse you every moment at your desk. There is a benefit: everyone who looks in at you thinks you are just swamped with work, which is particularly useful if one of those everyones is your supervisor. Yet it is even more true that it appears to you that you are swamped with work.

When people have lists of work I have heard various strategies. Do the hard ones first. Do the easy ones first. Pick something you really dislike and get it out of the way. I don’t think it matters, or rather, what is best for one may not be best for another. But do something. Get it off your desk, to wander through the next part of the bureaucracy as SEP – Somebody Else’s Problem.

You will seldom get to 100% on this. There will always be something lying around undone for reasons you can’t control. These will discourage you less if you are in the general habit of grabbing something, doing it, and crossing it off the list. The possible downside is that others might think you don’t have much going on and will want to borrow you. You can stave this off somewhat by leaving books and semi-useful pieces of paper stacked up. I recommend piles of your most commonly-used forms, so that you have this visual filing system.

I think I just explained to myself why the stuff to be done around the house is discouraging.

* There is a difference between doctors and lawyers in this that leads to misery. Doctors and medical people in general develop the skill of giving necessary information quickly and not repeating the unnecessary. Legal documents, however, have to have everything nailed down to avoid misinterpretation (or shennanigans), and lawyers need you to be that specific. Maybe when they talk with each other they can do the quick-communication, and I think they can turn the excruciating detail thing off in other situations. Doctors and nurses like to whittle things down farther and farther, like “O-sats 92-96.” (Or “Pulse ox.”) The fun there is that you can use cool verbs like “tweak,” “bump,” and “bang” and still sound scientific.


Der Hahn said...

I like the axiom attributed to Patton... a good plan executed immediately is better than a perfect plan executed too late (something like that).

Larry the Cable Guy is probably even more to the point.. Git-R-Done!

Michael said...

I hate to tell you, AVI, that lawyers are like that all the time. They get into the habit of using 5 words when 1 will do and can't shake it. The lawyers I like to see come in for a hearing are the ones that don't subscribe to that theory, and they usually get the benefit of the doubt, if one can be given. The ones that waste your time never get that benefit.