On Saturday I acquired an e mail from the Workplace of Personnel Administration in Washington, with the topic line: “What did you do final week?” OPM runs the civil service, and as a essential care doctor and medical director of intensive care models in federal, native and rural hospitals, I’m partially a authorities worker.
I questioned learn how to reply the e-mail. Was I supposed to spotlight what truly mattered — the human lives in my care — or checklist what OPM may deem necessary, in a bureaucratic train? With out context, the request felt largely like a requirement, not a authentic inquiry. The shortage of respect was palpable. A colleague needed to level me to information articles concerning the e mail — a brand new wrinkle within the Trump administration’s chaotic method to authorities effectivity — earlier than I might even decide whether or not it was a hoax or a phishing rip-off.
If Washington actually seeks to know the work I do, or to foster organizational change, frequent sense tells you there are higher methods. Efficient management requires clear communication, considerate evaluation and — above all — belief. This e mail had none of that.
However since they requested, right here’s what I did final week:
- I cared for Darrell, a 70-year-old veteran with a kidney transplant and sepsis. He had a painful, life-threatening fluid assortment in his chest that I drained to alleviate the stress.
- I sat for hours with the household of an 85-year-old veteran with Parkinson’s, coronary heart failure and a recurrent MRSA an infection. Collectively, we navigated the advanced, usually politicized panorama of end-of-life care.
- I recognized and assessed lung illness severity for greater than 50 veteran sufferers.
- I audited 20 affected person charts for coding accuracy and strategized about learn how to enhance compliance.
- I supervised, coached and skilled virtually 10 medical trainees each day within the care of critically sick sufferers.
- I labored with pharmacy and nursing supervisors to refine a novel protocol for treating alcohol withdrawal, a life-threatening situation.
- I coordinated with pharmacists, nurses and cardiothoracic surgeons on secure, cost-effective dosing methods for amiodarone, a coronary heart rhythm medicine.
- I organized the advanced switch to a different hospital of a veteran with liver failure and an acute joint an infection who required specialised surgical procedure, and I attempted to assuage his nervousness, together with whether or not insurance would cover him when he got there.
- I answered detailed questions on blood transfusions for an 84-year-old man with metastatic bone most cancers whose transfusions had exacerbated his coronary heart failure in a suburban hospital.
- I intubated an 82-year-old man and put him on a ventilator after he returned from Europe with a devastating respiratory virus. Earlier than sedation, he stated goodbye to his household, not figuring out whether or not he would get up once more.
- I managed doctor schedules in a rural ICU stricken by perpetual funding shortfalls.
- I handled a 62-year-old former nurse affected by extreme melancholy and alcohol-use dysfunction who had tried suicide by overdosing on a number of antidepressant drugs.
- I wheeled an ICU nurse to the emergency division when she fell sick mid-shift, burning with a 103.5-degree fever.
- I strategized about making use of for potential philanthropic help for doctor burnout analysis given National Institutes of Health funding cuts.
- I cared for an 80-year-old man with a number of mind hemorrhages and an obstructed bowel, stabilizing his blood stress with infusions.
- I comforted the household of a 76-year-old lady whose uncontrolled hypertension had brought on a catastrophic mind hemorrhage. She was in a near-coma. After hours of debate, they elected hospice, and he or she handed away peacefully that night.
I might go on.
Right here’s my query: What did the Workplace of Personnel Administration do final week? Did it assist me handle these sufferers, or did it burden a system already buckling underneath its personal weight?
Earlier than OPM solutions, I’d counsel it acknowledge that the work my colleagues and I do is precisely measured not on a spreadsheet however within the lives we save, the households we information by means of loss and the following era of physicians we practice to do the identical.
That’s what I did final week. What is going to OPM do subsequent?
Venktesh Ramnath is a pulmonologist and demanding care doctor in Southern California. He’s an affiliate professor at UC San Diego Well being, medical director of the San Diego Veterans Affairs intensive care unit and medical director of El Centro Regional Medical Heart intensive care unit.
