12 July 2006

Playing with people's lives

You'd think, just from working in the ER, I'd be okay with the heavy weight of responsibility. You'd think I'd be used to the fact that the things I do have a big impact on the lives of the people I see and care for. But it's not really so. You see, ninety percent of the people I see, on average, are perfectly fine, or only chronically ill, or ill but in a really obvious way that is easy to fix. The remaining ten percent are a challenge, and it's a little scary, like treading in a minefield, trying to figure out who they are. But mostly I get it right, and mostly the cases that go bad were not my doing, but the consequence of some bad disease. So even when someone dies on me, though I feel badly, I don't exactly feel responsible. The point is that barring a really great, tricky diagnosis, or a remarkable fuck-up, 99% of my patients will get better or worse regardless of what I do.

But now I am engaged in a process that will take people out of their homes, uproot their families, disappoint and devastate some, and elate others. It will impact 100% of the individuals I am seeing.

We're hiring.

And I am the lucky soul that gets to do all the hiring. It's completely up to me. I get to review the CVs, conduct phone interviews, check references, bring them out for a tour and meeting, and make the final decision. I hate it.

We're a good ER group to work for. We are in a desirable location, independent, democratic, and have a good payor mix. No sooner had I put the word out than I had 20 CVs, maybe half a dozen of which were competitive. I have been conducting the phone interviews first. It's painful listening to these candidates go through their paces, hearing them try to communicate to me how they really are a great ER doctor, hearing how badly they want this job, trying to interact on a collegial, personal, human level, while remaining impassive and reserved with my comments. I hate liking several of them and knowing in the back of my mind that I am unlikely to hire him/her. I hate having a 'get to know you' chat and not being able to ask about their marital status, kids, religion, or a host of other personal data that usually informs one about a person. But mostly I hate being in the position of sitting in judgment on these people.

It's funny. Those who know me will attest that I am the most opinionated and judgmental person they know. But it's easy to be judgmental when there are no consequences to one's judgments. Powerlessness is a sort of freedom, when it comes to opinions. But now I am going to make several people fly thousands of miles for a two to four hour interview, then I will get to choose the lucky ones who will have the opportunity to sell their homes, pull their kids from school, and move to our neck of the woods. And if I have chosen badly, I'll get to fire them in a year.* And I get to tell the other contenders that, thanks for playing, but you are not a good enough doctor, a good enough person, nice enough or smart enough or well-bred enough to come work for us. I've been on the other end of rejection often enough to dread those phone calls. (can I do it by letter? It seems very wrong.)

There's an up-side here -- we will, at the end of the day, have some new partners, new colleagues to work shoulder-to-shoulder with, new peers and maybe even new friends. So I shouldn't be so down on the process -- it is really a great opportunity in its own way.

But it is in its way much harder than the clinical work I routinely do. Which is a little remarkable.

* Not that I would anticipate such an occurrence. But it has happened in the past, and is incredibly painful. A personnel mistake is so hard to undo. The potential consequences weigh very heavily on my mind.


  1. Hey, I'm looking for work. I'm not exactly what you would call a "doctor" and I wouldn't argue too strenuously that I'm what most people would consider "qualified", but I really need a job and a change in life, so why not take a chance on me? You know you'd like having me in the area, and you know my wife and kids so all that hard stuff you talked about would be the easy part!

    And I can get used the bad feelings of my own incompentence and the results on the life and health of other people, so I guess I'm perfect.

    So, how about it?

  2. Things could be more difficult. You could be firing.

  3. I think that Matt Dick guy sounds like your man. If you decide not to go with him, I am an intern and hear that the Northwest is beautiful. Ha Ha.

  4. This Michael character I've heard so much about seems like an upstanding young man, and an excellent judge of character. I say go with his judgement and hire me forthwith!


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