1/ "If doctors and nurses #clocked out when their paid #hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk.

The system knows it, too, and takes advantage." @danielleofri nyti.ms/31ma6Qz

2/ "Increasingly, though, I’ve come to the uncomfortable realization that this #ethic that I hold so dear is being cynically #manipulated.

With mergers and streamlining, it has pushed the #productivity numbers about as far as they can go."

3/ "By now, corporate medicine has milked just about all the 'efficiency' it can out of the system."

I often think about this from an educator perspective too. My residents often say 'I just don't know how I can be any more #efficient" #MedEd

4/ Honestly, sometimes I dont know either. There's the efficiency of logistics that come with high #turnover and extra tasks but then there is also our cognitive load - our capacity to listen to our patients, #learn and #think deeply about their health

5/ We have hospitals that rely on our #ethics as @danielleofri points out but also 'best case scenarios'

That you won't walk into 5 new admissions, 4 discharges, 2 rapid responses, agitated patients that needs to be held down by 6ppl, struggling learner etc.

6/ i.e We are setting trainees and healthcare teams for #failure, moral injury and distress giving haphazard care.

Business of healthcare doesn't take into account that non-factory work of the hospital. All the moving parts that are out of anyone's #control.

7/ Who is doing this right? Who is working in a system where everyone is NOT stretched thin? What will is take for #change? Will take some important person's family member having a bad outcome? How has change happened in the past in medicine?

@ShreyaKangovi @sarahgcandler @ShannonOMac @laxswamy @choo_ek @subhaairan @sue_bornstein @EileenBarrettNM @DrPoorman @FutureDocs @choo_ek @arghavan_salles @mike_natter @gradydoctor @ZackBergerMDPhD @DhruvKhullar Would love other's reflections