A few months ago, my husband and his brother took me to my first professional basketball game. Prior to this, the last basketball game I had attended had been to watch from the corner of my eye as my middle school boyfriend and his teammates trekked up and down the court, facing the team from a neighboring district, as my girlfriends and I gossiped and giggled. At this more recent game, my husband and brother-in-law laughed at my reactions to the barely-clothed dancers who gyrated during extended time-outs and at the way that my interest was only piqued by the Big Wheels race for children held on the court at half-time. The rest of the time they spend in detailed analysis with one another while I gazed around the arena and daydreamed.
But one of the things that really struck me was the treatment and behavior of the players, the way that a man about to substitute for his teammate would rise from the bench, pull off the T-shirt layered over his jersey, drop it to the floor and step out onto the court without giving it a second glance. The job of retrieving it fell to the ball boy or some similar team employee, who would scurry quickly to grab it before retreating back out of the limelight.
I grow irritated when people don’t pick up after themselves, and even more so when they expect others to do it for them. I scold my husband for this repeatedly, when he leaves that day’s tie on the shelf in our entryway, having shed it the moment he walked through the door, or his shoes one in front of the other, in the exact position that he stepped out of them, along the hallway leading to our bedroom, as if they had begun to walk themselves back to their home in the closet but hadn’t quite made it to their destination.
The subtext that I read from such actions is that the perpetrator views himself, or his time, as more important that someone else’s, and that it is appropriate for that other person, who holds a lower position, to cater to the first. And I began thinking about similar situations that occur in medicine, the way that doctors, and attending physicians in particular, have many tasks completed for them, tasks that wouldn’t necessarily cost them a lot of time, but that just make their lives a little bit easier. For example, in hospitals that still utilize a paper medical record, each patient’s chart is often bookmarked, allowing the attending to open it to the next blank page rather than having to rifle through it before beginning the day’s progress note. In other places, the page for the day’s note is removed from each patient’s chart, and once the notes are written, the pages are filed back in their proper places – by someone other than the attending.
These are small courtesies, to be sure. They don’t occupy a large portion of the day for the person who performs them, nor would they occupy a large portion of the attending’s time. Some would argue that physicians who have completed four years of college, four years of medical school, and at least three years of residency potentially followed by fellowship have earned exemption from certain more menial tasks. Perhaps I am too early in my training to share this feeling of entitlement, but I am uncomfortable with any special accommodations that stem from status alone. Certain divisions of labor are appropriate and necessary for the flow of an organization; ball boys, not the players, should retrieve balls that have traveled out of bounds in order not to delay the progress of the game. Similarly, nurses administer vaccinations to children at the end of my clinic visits, which allows me to move on to the next waiting patient. But I do feel that, when I am an attending physician, I will not be too slowed by the need to flip through the chart to find a blank page.
I recently came across a charming blog post entitled “Physicians: Learn to pick up the proverbial poop.” The author describes his experience being a clown in the circus and seeing the elephant tamer, the man with the highest status in the show, helping to pick up the elephant droppings after the performance. He draws from this a lesson that can be applied to physicians, managers, and any professional operating in a hierarchical setting: when leaders indicate through their actions that no task is beneath them, they set an example and promote a culture of teamwork from which everyone will reap benefits.
I haven’t been to any basketball games lately. And I am certainly far from being offered any of the courtesies reserved for attending physicians. But my irritation at these seemingly innocent yet powerfully charged distributions of tasks has made me determined to pay closer attention to my treatment of coworkers in different areas of patient care and of medical students – of anyone who could potentially feel compelled to show deference to even a junior physician. I appreciate their respect, and hope that we all demonstrate mutual respect for one another, but I don’t deserve special treatment. We may have different tasks, but we’re all in the business of caring for patients together.