On Saturday I obtained 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 vital care doctor and medical director of intensive care items in federal, native and rural hospitals, I’m partially a authorities worker.
I questioned the best way to reply the e-mail. Was I supposed to focus on what really mattered — the human lives in my care — or listing what OPM would possibly deem vital, in a bureaucratic train? With out context, the request felt largely like a requirement, not a legit inquiry. The shortage of respect was palpable. A colleague needed to level me to information articles concerning the e mail — a brand new wrinkle within the Trump administration’s chaotic method to authorities effectivity — earlier than I might even decide whether or not it was a hoax or a phishing rip-off.
If Washington really seeks to grasp 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 strain.
- 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 advanced, usually 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 the best way to enhance compliance.
- I supervised, coached and educated nearly 10 medical trainees every day within the care of critically ailing 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 advanced 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 nervousness, together with whether or not insurance would cover him when he got 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 affected by perpetual funding shortfalls.
- I handled a 62-year-old former nurse affected by extreme melancholy 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 ailing mid-shift, burning with a 103.5-degree fever.
- I strategized about making use of for potential philanthropic help for doctor burnout analysis given National Institutes of Health funding cuts.
- I cared for an 80-year-old man with a number of mind hemorrhages and an obstructed bowel, stabilizing his blood strain with infusions.
- I comforted the household of a 76-year-old girl whose uncontrolled hypertension had triggered a catastrophic mind hemorrhage. She was in a near-coma. After hours of dialogue, they elected hospice, and she or he handed away peacefully that night.
I might 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 recommend 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 way of loss and the subsequent era of physicians we prepare to do the identical.
That’s what I did final week. What’s 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.
