{"id":2461,"date":"2018-08-28T16:52:36","date_gmt":"2018-08-28T20:52:36","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2461"},"modified":"2018-08-29T09:02:19","modified_gmt":"2018-08-29T13:02:19","slug":"so-lets-have-a-chat-about-extracurricular-work-activities","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/08\/so-lets-have-a-chat-about-extracurricular-work-activities\/","title":{"rendered":"So Let’s Chat About Extracurricular Work Activities"},"content":{"rendered":"
\"Justin<\/a>

Justin Davis, MBBS, is a Chief Resident at Barwon Health in Geelong, Australia.<\/p><\/div>\n

Well, we\u2019re finally here. Somehow, an Aussie has sneaked onto a United States-based Chief Resident blog panel dealing with pertinent issues within medicine, and I actually have to think about what to write. (I\u2019m being slightly facetious here, by the way.) So let’s start, shall we?<\/p>\n

One of the things that has been on my mind recently, and I think even more so since starting advanced training,\u00a0is the amount of extraneous work we have to do in this career (read: lifestyle) we call medicine. (Note:\u00a0for context, for our American audience [and I assume most people who read this will be from the U.S.], in the Land Down Under,\u00a0physician training requires you to do 3 years of basic training as a medical registrar [internal medicine resident] and sit two exams before applying for specialty training, which we call advanced training.)<\/p>\n

\"\"<\/a>

“You is unpaid overtime” \u2014 A wiser man than\u00a0I annotated this poster up in our ressies room. Personally, I think it speaks volumes to the amount of extra work we have to do\u00a0in our\u00a0profession.<\/p><\/div>\n

Now I think it\u2019s important to realise that I\u2019m not talking about unpaid overtime here \u2013 that topic has been done to death in previous chief resident posts because it\u2019s a hotly debated topic in several spheres of medical influence. I mean, who amongst us hasn\u2019t done it? From patients being unwell, to clinics being overbooked, to the emergency department somehow having soothsayer-like ability to know exactly when to refer a patient (i.e., half an hour before\u00a0you think you\u2019re going home for the day, on time for once), to just generally being overworked\u00a0because that\u2019s what the system demands of you. Rather, what I\u2019m talking about is extra work that we have to do, which isn\u2019t<\/em> directly related to patient care. And there is a surprisingly large amount of it.<\/p>\n

I started to ponder this one evening as I sat in what I affectionately call \u201cthe Bungalow\u201d (the name for my office [see included photo], which I\u2019m, in reality, quite appreciative\u00a0to have this year \u2013 it sure beats the old medical registrar office that I used to sit in to do these sorts of things).\u00a0 I think it was a typical sort of day; you know \u2013 start work at 8 am, finish at 7 pm (only 1.5\u00a0hours late this time), cook dinner, and then return about 8 pm\u00a0to work until about midnight\u00a0on things that are not directly related to your clinical role per se<\/em>, only to wake up at just before 7 am to do it all again. I also realised that I really probably shouldn\u2019t complain \u2013 my surgical colleagues work much more ridiculous hours than I do, and our hours are a lot better than what is mandated over there in the U.S. It is also true that medicine is nowhere near unique in having these sorts of extracurricular (I honestly cannot think of a better name for this than that) requirements\u00a0or unpaid overtime-type issues. But, it still affects us, our partners, our lifestyles in general, and thus I think it remains an important topic to talk about.<\/p>\n

\"\"<\/a>

“The Bungalow,” complete with my own laptop for music. I feel the $10 plastic plant I got from Kmart adds a class of sophistication to it. Maybe.<\/p><\/div>\n

What I want to\u00a0chat about today is the amount of extra activities we find ourselves doing outside of our clinical role, just to progress through the world of medicine. We know why we do them \u2013\u00a0they’re resume building, and\u00a0a chance to\u00a0impress superiors and build important relationships that determine your future eligibility for employment.\u00a0The work is<\/em> important and does<\/em> need to be done, but it\u2019s all done outside of usual working hours because it simply cannot fit into that time (how could it possibly?) and thus ends up being lumped into this misery mire I call extracurricular work activities.<\/p>\n

As I\u2019ve noted, it is<\/em> important work, and it does<\/em> provide you with important skills that are translatable in clinic and\u00a0in life, but it does take\u00a0its toll. I think back on all of the extra stuff I\u2019ve done outside of work hours in this previous 6 months\u00a0\u2013 I\u2019ve organised part of the Royal Australian College of Physicians clinical examination (it\u2019s surprising how long it can take to organise a patient’s complete medical history,\u00a0medication list, investigations, and imaging requests, when\u00a020+\u00a0of them need to be done), prepared morbidity and mortality meetings, prepared several manuscripts for \u2026 um, five research papers that are currently active, prepared multiple choice questions for medical students, prepared talks to give to\u00a0other specialties, and attempted to do a Bland-Altman plot in Microsoft Excel (this was really hard, by the way) to plot 15000 data points\u00a0of ultrafiltration values.\u00a0All this is before<\/em> I do things like my own regular self-directed learning (I think people may have the wrong idea that study stops once your exams are over. It doesn\u2019t. It just becomes more clinically focused and relevant to your chosen specialty.) I can\u2019t see my patient with primary focal segmental glomerulosclerosis (FSGS) who has already failed glucocorticoid therapy without having some idea of what to do next now, hey? I’m also attempting to keep up with the latest research\/commentary from publications such as the New England Journal of Medicine Journal Watch<\/em> (sneaky plug here), or just, you know, having a life outside of medicine (I really do enjoy playing video games. Ah, well).<\/p>\n

\"\"<\/a>

Sometimes, I’d much rather be putting my feet up with Einstein next to me. These moments are rare, so I appreciate them when I have them.<\/p><\/div>\n

But \u2026 we know why we do it. We love this job. I went into nephrology not only because the kidney is awesome and is clearly the best organ (subjective personal opinion), but because my favourite part of working is building up those longitudinal relationships with patients, being with them through a hell of a lot of different circumstances, from their first presentation with renal failure to dialysis to transplant to failing transplant and back to dialysis and so on. And I know that an important part of being a well-rounded clinician is not only knowing the clinical side of things but all\u00a0the extra work that goes into keeping the grinding wheel of medicine turning \u2013 how else could we train future generations? How else could we improve our own practice or systems processes\u00a0except with\u00a0an\u00a0M&M meeting? How else could we improve clinical practice without research into how we can be better? So despite the hours it takes away from my own life, I realise there is a point to all the extracurriculars, and\u00a0they are\u00a0an important part of things. Although I do admit it would be nice sometimes to be putting my feet up on the couch and turning on my PlayStation with a nice glass of red wine \u2014\u00a0as opposed to sitting in the Bungalow, iPhone blaring Mozart\u2019s 21st piano concerto in a really tinny way, and working on some extracurricular thing into the late hours. But hey, would I choose anything else? Realistically\u2026 probably not.<\/p>\n

\u201cIt is not the height of the cliff, but the struggle of the climb that clears my eyes.\u201d<\/strong><\/em><\/p><\/blockquote>\n

Note: Every blog post I do will be followed by a quote from a particular source for my own amusement which shall remain nameless \u2013 there are, of course, bonus points to anyone that can figure out from where I am sourcing these quotes*.<\/p>\n

* These bonus points have no monetary or other value. Just my respect.<\/p>\n

 <\/p>\n

\"NEJM<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Well, we\u2019re finally here. Somehow, an Aussie has sneaked onto a United States-based Chief Resident blog panel dealing with pertinent issues within medicine, and I actually have to think about what to write. (I\u2019m being slightly facetious here, by the way.) So let’s start, shall we? 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