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 important care doctor and medical director of intensive care items in federal, native and rural hospitals, I’m partly a authorities worker.
I questioned tips on how to reply the e-mail. Was I supposed to focus on what really mattered — the human lives in my care — or checklist what OPM would possibly deem vital, in a bureaucratic train? With out context, the request felt largely like a requirement, not a authentic inquiry. The dearth of respect was palpable. A colleague needed to level me to information articles in regards to the e-mail — a brand new wrinkle within the Trump administration’s chaotic method to authorities effectivity — earlier than I may 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, widespread 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 complicated, typically 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 tips on how to enhance compliance.
- I supervised, coached and skilled nearly 10 medical trainees day by day within the care of critically in poor health 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 protected, cost-effective dosing methods for amiodarone, a coronary heart rhythm remedy.
- I organized the complicated 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 anxiousness, together with whether or not insurance coverage would cowl him when he bought 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 mentioned goodbye to his household, not realizing 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 despair and alcohol-use dysfunction who had tried suicide by overdosing on a number of antidepressant medicines.
- I wheeled an ICU nurse to the emergency division when she fell in poor health mid-shift, burning with a 103.5-degree fever.
- I strategized about making use of for potential philanthropic assist for doctor burnout analysis given Nationwide Institutes of Well being 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 she or he handed away peacefully that night.
I may go on.
Right here’s my query: What did the Workplace of Personnel Administration do final week? Did it assist me deal with these sufferers, or did it burden a system already buckling below 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 loss and the following era of physicians we prepare to do the identical.
That’s what I did final week. What is going to OPM do subsequent?
Venktesh Ramnath is a pulmonologist and significant 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 Middle intensive care unit.
