Monitored

A hospitalist encounters a new efficiency system.


I was the lead hospitalist for a group of physicians, nurse practitioners, and physician assistants. We had been part of a private corporation that had first been bought by a larger corporation, then by an international health consortium. That consortium was subsequently purchased by a tech billionaire (primarily for its assets in Cyprus), and the health care unit was spun off and sold to a holding company that ultimately sold it to an international retail chain interested in developing new models of medical practice. These transactions occurred within a space of 18 months, but there was little oversight of our 18-person “work unit,” and we had no complaints about that.

Illustration by David Rosenman
Illustration by David Rosenman

One Monday morning I was paged in the middle of morning rounds. I was in an isolation room, bedazzled with C. diff, MRSA, and VRE, and not about to reach for the annoying vestigial communication device. I eventually exited the room and was speaking with the nurse when my pager beeped again. It was the same number, this time with three exclamation points. It was not a familiar extension. I finished the discussion and put in some essential orders, then called the mysterious number.

It was answered by an atonal voice. “Doctor, it took you 7 minutes and 30 seconds to respond to the page. Our expectation is that all pages will be answered within 4 minutes. This has been a test of the new paging response system; please return to your clinical duties.” I was flabbergasted that this inhuman voice had just remonstrated me on my response to a system I knew nothing about.

Later that morning I passed by a colleague in obvious distress who told me he had to get more efficient and had no time to talk. I, on the other hand, had seen all 18 of my patients, finished rounds, and written all my notes by 11 a.m. I headed to the lounge for a well-earned coffee, two cups behind my normal caffeine-loading. I spotted an old friend there who had begun to tell me a somewhat salacious tale when my pager went off again, the same extension. The voice on the line was anything but mellifluous. “Doctor, you scanned into the lounge at 11:05, and it is now 11:27. You are over the approved 15-minute break time, and you are not logged into a clinical workstation. Please return to your clinical duties.” My head was about to explode. I wasn't about to be micromanaged by a disembodied voice that had already hung up on me. I dialed the extension back, but there was no answer.

Over the next hour I received messages from all of my colleagues, agitated by similar calls. One somewhat obstipated PA had even been interrupted in the bathroom for being in the stall longer than 7 minutes. This was absurd. As putative leader of the hospitalist group, I'd get to the bottom of it. However, every time I sat down to try, my pager would go off again. It was negative feedback conditioning. When my admission window closed at 4 p.m., I tried in earnest to figure out the origin of these pages and how they were tracking our every movement (or in the PA's case lack thereof). But my efforts were fruitless. I tried a variety of extensions, numbers, websites, emails, and social media accounts. My shift was over; it was dark outside and time to leave.

But at that moment I received a page to the dreaded extension. I answered with an expletive, and before the voice could speak, launched into a detailed account of my complaints and a variety of other suggestions not suitable for the general public. Eventually I ran out of verbal steam. The voice said, “You spent 6.2 minutes on that monologue. Thank you for your vital input, which will be reviewed per our policy. You have been surveilled by our efficiency team today as a part of a systemwide roll-out. This pilot will continue for the next six months, and we greatly appreciate your voluntary participation. Rounds start at 7 a.m. sharp tomorrow. Be sure to get adequate rest, exercise, and nutrition in your off hours to maintain a healthy quality of life.” The phone line went dead.

This should have been a pleasant day at work. Given that it had been anything but, I decided to work out some aggressions on the squash court. The traffic on the way to the gym was pretty rough, but I was still 20 minutes early for my court time. I was sitting in the coffee shop having a prematch caffeine load when my pager went off. I couldn't believe it. I dialed the dreaded extension.

“Doctor, your transit time was 5 minutes longer than expected. We suggest you take the 42nd St. exit next time. You are now located in the club lounge, not stretching, and risk a sports injury. Please proceed to the exercise floor for adequate warmup. If you do not, any injury will not be covered by your disability policy. Your partner has checked in and the court will be available in 10 minutes. Our analysis shows your opponent was having trouble with his mouse today. We suggest you hit to his backhand.”