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Quality time

From the September ACP Hospitalist, copyright © 2012 by the American College of Physicians

By James S. Newman, MD, FACP

The alarm blasted me out of the sweet and sadly underused arms of Morpheus, the god of sleep. I had logged 7.3 hours, well within my established workweek range of 7 to 8.5 hours of daily shuteye. Expecting public radio, my golden slumber had instead been interrupted by the cacophonous sound of rap. I had created strict criteria that my bedside radio tuner should not be touched or changed from its approved settings. Based on the station choice, it seemed likely an in-house teenager had performed an unauthorized adjustment. I had zero tolerance for this type of behavior. A report would be filed.

I went into the bathroom, took care of business, and subsequently left the lid down per a recently reconfirmed protocol. My toothbrush was in its proper location, but the toothpaste had been squeezed from the middle. Evidence reviewed at our last family council indicated that middle-of-the-tube squeezing leads to inefficient toothpaste use and a higher incidence of cap crusting. Though not a reportable event, it was still a concerning sign of noncompliance to established guidelines. Indeed, improper tube usage was a warning sign of more severe toiletry dysfunction.

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Courtesy of James S. Newman.

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Once I reached the kitchen, the coffee tasted fine and appeared to be in an appropriate temperature range. There had been an issue when centigrade and Fahrenheit measurements had been reversed and an oral scalding event had ensued. A universal metric measurement system was then adopted for the entire domicile.

I was listed on the Pet Feed and Maintenance Schedule (PFMS). Each dog received exactly eight ounces of kibble, and both cats got four ounces of dry food each. The litter boxes were at only 40% capacity, so cleaning was not indicated. The birds were marked as part of the evening protocol. Yard clean-up was scheduled for Saturday; I would be off PFMS duty by then, I noted with satisfaction.

I had created strict criteria that my bedside radio tuner should not be touched or changed from its approved settings. Based on the station choice, it seemed likely an in-house teenager had performed an unauthorized adjustment. I had zero tolerance for this type of behavior. A report would be filed.

My third of four offspring approached me for his allowance. He presented a signed affidavit from his maternal supervisor that he had accomplished all assigned tasks for the approved time period. Bed made on school mornings: more than 80% compliance. Garbage by the curbside with recycling separated: 100% compliance. Clothes put in hamper, face washed, dental hygiene and shower completed within previous 24 hours: mostly compliant. With all the boxes marked on his checklist, I gladly gave him his approved remuneration. Sadly he did not receive his 10% pay-for-performance bonus, having failed to maintain a 4.0 score on his report card. I also had held back 5% for failure to maintain weather-appropriate attire.

I went out to my car. I was running slightly behind schedule but still within one standard deviation of acceptable limits on my time. I pulled out my checklist. One approved set of keys, check. Mirrors adjusted, check. Seat in proper position, gas tank greater than one-third capacity, tires at spec limits for PSI air pressure. Check, check, check.

I drove down the hill, signaled the left turn and pulled out onto the county road. I was driving at 45 miles per hour, the upper limit for acceptable speed. As usual, the cars piled up behind me, many applying the acoustic accoutrement of their vehicles in a repeated honking pattern. Still, I was not about to exceed tolerable velocity limits and risk a citation.

At work, my favorite space in the parking garage was an ideal mix of distance from the exit, shade, and risk of door-induced paint scratches. Sadly, it was taken. I headed up the ramp to survey several secondary choices, but they were full as well. Finally I went up to the roof to the last open place in the garage—the worst possible spot, but my only remaining option.

I walked into the morning report room. Everyone was gone; I had missed morning checkout. I was the one who had insisted on established and measured parameters for checkout, including adherence to specific times. I looked stealthily around; it seemed like I was alone. I began to tiptoe out—no harm, no foul—and ran smack into my clinical assistant, watch in hand.

“Sorry, Doctor,” she said in a too-satisfied voice. “That's the second missed checkout this quarter. This is really going to downgrade your score.” I could kiss my top 10% ranking goodbye.

Several phrases came to mind: “Hoist with my own petard” and “He who lives by the sword dies by the sword.” But instead I chose, “The quality of mercy is not strained.” I decided to be merciful on myself, and avoid too much strain worrying about lapses in my quality. I had too much to worry about with monitoring everyone else's.

Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn. and the editorial advisor and humor columnist for ACP Hospitalist.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated