Stupid stuff is burning us out: a lesson in saying ‘No’

“When you say ‘Yes’ to others, make sure you are not saying ‘No’ to yourself.”—Paulo Coelho, Brazilian lyricist and novelist.On a circus afternoon like many others—juggling demands of patients, pharmacies, facilities and vendors—a call came from the coroner, bringing bad news and an important lesson.I identified the deceased as my patient and explained the likely cause of death, but as I tried to end the call and continue my day, the coroner interrupted me: “Uh, thank you, doctor. Here’s the number to submit your report.”“My . . . report?” I replied incredulously as my EMR mockingly reminded me how long my next patients had been waiting for their appointment. “Yes, doctor. Please complete a death certificate for this patient.”Read: Dr. Eric Cadesky: Chart it: Every. Single. Time.Now I’ve long had issues with death certificates and I am sympathetic to coroners who spend their days delivering bad news. On the one hand, these forms are a legal duty and I understand the need for proper documentation and statistics. On the other, it’s an unpaid demand on physicians’ time. We cannot bill public healthcare plans because benefits stop at death. We could send a bill to our deceased patient’s grieving family or estate, but who wants to be that person who does that? (Perversely, if the family wants a copy of the death certificate that we write for free, the government charges and keeps $27.)Stressed, hungry and peeved, my inner D-Fens erupted. “Sir,” I asked with exasperation, “are you paid for your time in calling me?”“Yes, doctor, I am.”“And would you be paid for documenting what I’ve told you and then completing this death certificate?”“Yes, doctor, I would.” “Sir,” I informed him, “I am paid for neither. Why should you be treated differently than me?”After an awkward pause he replied that he would complete the form. As doctors there are many demands on our time beyond clinical care, such as documentation, reviewing results and consultations, writing prescriptions, reading around cases and replying to pharmacies, colleges, colleagues and administrators. We are told to set boundaries but also to work with EMRs that take up a third of our time, drawing us away from patients and pressuring us to complete our duties during pajama time and pretend time off.So, when a demand on our time can be done by someone else—or perhaps doesn’t need to be done at all—it’s in all our best interests to set boundaries. We can say no to chiropractors’ requests for back imaging “to see what’s going on.” When possible we can say no to referring to clinics that require us to transcribe already-sent information onto “their form.” When an insurance company asks us to complete a form or send chart notes we can say no to doing it for free. We can demand that administrators, politicians and medical associations know that stupid stuff is burning us out: we need the right to say no or to be paid fairly for our time and expertise.Perhaps with this collective action, we will have more time for our patients, our families and ourselves. And perhaps one day in our system, when a coroner wants to download unpaid labour onto us, they’ll kill the idea before it kills us.Dr. Eric Cadesky is a family doctor in Vancouver.

Stupid stuff is burning us out: a lesson in saying ‘No’

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