A Worthy Endeavor

The word o' the day is diligence. Diligence is defined as "persevering and careful in work, hardworking". Alternately, as defined in Atul Gawande's Better, "the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles". According to Gawande, diligence is both central to a physician's performance and very difficult to accomplish on a day to day basis. I would have to agree with him. How many obstacles do we as physicians encounter on our quest for diligence? Let's see...fatigue is a biggie. This one is near and dear to my heart because, i'll admit it, at 3am (which will hereby be referred to as the witching hour) I am struggling to put out fires and keep everyone alive until the reinforcements show up. The only obstacle against which I'm trying to prevail is the mud in which my thoughts have become hopelessly tangled and mired. Not that I don't try. There have been plenty of times when I lay down to catch that 1 precious hour of sleep before morning labs come back and I think "Is that baby peeing enough? Well, the nurse would tell me if she isn't. Wouldn't she?". I put my shoes back on and leave my dark call room to check on that baby's urine output. But does that happen every single time?  Another obstacle is time. I know from my clinic based colleagues that having enough time to give the patients what they need AND get what you need from them AND write orders AND document AND communicate with staff AND breathe is next to impossible. But I know they do their best until that last appointment of the day. For residents, the duty hour regulations presents a double edged sword. They have the same amount of work to do in a shorter period of time. They have to be even more efficient in their work and pay even more attention to detail because there are so many patient hand offs these days.  A study published by Landrigan et al in Pediatrics in 2008 showed that after duty hour implementation, there were no changes in the rate of medication errors and a borderline increase in resident ordering errors. Are we as their mentors teaching them how to be diligent while maintaining efficiency?

Consider your own obstacles to diligence in your career. Do you strive to be diligent in what you do every single day? Why not? As physicians, what are our rewards for diligence?