RE: Your Mohan Post, I saw someone's tags on a gifset and I was like wait wait, here's another thing:
Speed is incredibly important in an ED. We can talk about how doctors and nurses are forced to work more than able because of hiring practices and take on more-but I do think there is a point to be made by how Mohan's speed does affect others.
Like yeah, she takes her time and ultimately makes good connections with patients (which is why she has high satisfaction scores) but I wonder: if she was forced to move at the speed of her fellow residents, would her scores still be as good? I think the scripts and other characters reactions (such as Collins referring to her as slow-mo in the show, and Langdon doing so as well in a scene that was either filmed and deleted or simply just written) is that it also bothers them.
Like we see Langdon, who is only a year ahead of her, treat a lot more patients in season 1. And I think (even though part of its due to being in triage) when he comes back to the main hub he still is able to treat more, see more patients and be involved in more cases, even just for a few minutes. I think even McKay saw just as much if not a few more cases, or was involved in more.
To me I wonder: does she get too caught up in cases such as Orlando's often? I wish she was in season 3 to see more of this dynamic, but I also think her story ultimately ending with her not being a good fit for ED wouldn't have gone over well, despite the fact the show kinda says so.
Efficiency is really important. One of the most important skills in working in the US healthcare system at this moment is balancing the ability to connect with patients with the ability to see the number of patients needed.
I’ll just share what my experience is because I think it’s a good window into pace of practice that people not in healthcare might not know or understand. My training is in internal medicine and I work in primary care and urgent care at a community health center that takes care of mainly low income patients, the majority of whom are immigrants who do not speak English.
In primary care almost all my patients are elderly, extremely medically and socially complex and require an interpreter. Their visits are 15 minutes long. Think about that. 15 minutes for an 80 year old patient who has numerous health conditions, takes 20 medications, needs an interpreter for the visit, is marginally housed, and is afraid of being deported. That’s a typical visit for me. And I do that again and again, seeing 25 patients per day
I can’t run behind or my patients would wait hours and become angry and I would never go home. On top of that are administrative tasks for my panel of 1500 patients. You have to be efficient. You literally cannot do that job if you’re not committed to learning to be efficient. I have a wonderful friend who is so kind and thorough and she gets paid for 40 hours per week and literally works 80 hours because she spends time outside of work doing administrative tasks. This is unsustainable. This is why inefficiency contributes to burn out.
Now I don’t work in an ED but I do work in an urgent care. One shift I work with the kindest most empathetic doctor. She has Mohan energy with patients. They adore this doctor. And when we work together, in a four hour shift she might see ten patients while I see twenty. Now my coworker is kind and wonderful and doesn’t have Mohan’s attitude towards her colleagues so I don’t mind. But you can see how one doctor’s inefficiency makes a lot more work for the other doctor. It also means I just can’t take time with my patients. I have to have quick visits. I can’t take the extra few minutes to sit with a crying patient. Because in the waiting room people are cursing and threatening out front desk staff. And patients are coming out of their rooms and yelling at nurses about the wait time.
It would be wonderful if the system was built for doctors to spend hours with patients, but that’s not reality. Occasionally it has to happen with a special circumstance. But it can’t be the norm or the system falls apart and everyone suffers.
Geriatrics is a good speciality for slower doctors because you have longer visits and more support staff. But Samira would have to go into EM Geri which is different. She would still work in the ED. Otherwise she would need to redo her whole residency in IM or FM then do a geriatrics fellowship. And as someone who found residency to be some of the most challenging years of my life I cannot imagine choosing to do a second one.
Just figured I’d give some context since a lot of my thoughts on Mohan are shaped by having worked with very slow residents and interns both in the hospital when I was a resident and now when I supervise them. They cause real problems for teammates and patients. And residents are learning and so if they’re working on efficiency that’s great. But Mohan’s self-righteous attitude where she refuses to try to work on this is what gets me.