Most physicians love the profession. Our medical students and residents want to care for patients, interact with patients and help those patients. For most physicians, the joy of medicine occurs at the bedside and while investigating patient problems. The joy does not extend to scut work (defined in the free dictionary as “trivial, unrewarding, tedious, dirty, and disagreeable chores”).
Now who defines scut work?
Back in the 70’s, we would define scut work as drawing blood, carrying said blood to the lab, wheeling patients to x-ray, or starting IVs.
Today, scut work involves some of those issues, but more commonly filling out forms (especially pre-authorizations and anything an insurance company demands), writing notes and orders in the electronic record, writing notes that meet billing requirements rather than notes that convey important medical information.
Scut work, as physicians define it, remains the bane of our daily lives. Katie Hefner’s excellent New York Times article, “A Busy Doctor’s Right Hand, Ever Ready to Type,” addresses the documentation issue nicely. Chris Sinsky adds more texture in her important Annals of Family Medicine article: “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices.”
Being a physician is inherently joyful. We awake each morning, look at ourselves in the mirror, and understand that we have an opportunity to help patients today. Then we get to the hospital or the office and the scut work takes over, deflating our optimism. For over 40 years, I have heard residents, students and attending physicians talk about how much they like interacting with patients and how scut work dominates too much of their time. They consistently express a desire to do the things we train so many years to accomplish. Doing the other stuff discourages physicians and therefore patients and patient care can suffer.
We must all focus on the joy of medicine and work on ways to enhance that joy. Our profession is too wonderful to do otherwise.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
