Calling Dr. House: Moving from crisis mode to ‘deep work’

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  • Paul McIntyre says:

    Nicely articulated. Re “tension between…rapidly responding to urgent requests, quickly resolving large numbers of simple problems, all while vigilantly solving a small number of complex problems…” Some thoughts: Batching non-urgent task requests vs. serial interruptions.
    Creating “protected time” for thinking through complex patient problems.
    Cost effective deployment of NP or PA to manage straightforward tasks?
    Remuneration models that support these.

  • Dana Haas RN says:

    An insightful article and an issue that has increasingly concerned me. Not sure how we can change the system, but it needs to be changed. A very recent and personal example of this … my sister started the process to find the cause of her symptoms 3 years ago. Test referrals were “lost” and cavalier attention paid to getting timely assessment by her family physician. Multiple requests denied for additional evaluation as symptoms escalated. It was obvious to me that surgical intervention was indicated. We advised her to “hang out” in the ER until someone paid attention. The ER physician said “there is nothing we can do for you. You will just have to wait for your scheduled appointment with the specialist” (one month out after waiting 1 year, including a one and a half month reschedule due to MD vacation). I believe my sister would not be with us now had she waited one more month for a consultation based on a CT scan done 1 year earlier. Meanwhile, in the 3 previous months, she was rapidly losing all ability to care for herself and had lost 35 lbs – a current CT scan would have shown a tumour in her neck that had disintegrated two of her cervical vertebrae. There is more to this story and gaps in the narrative here, of course, but the dive would not have been too deep to see that the patient needed a more thorough evaluation, especially in the latter 3 months. Covid virtual visit weaknesses may not have picked up that she was emaciated and had the “look” of a cancer patient. Thankfully, a second visit to the ER two days later had a physician and nurses more willing to do deep work. Emergency surgery was performed within 5 days. She is slowly regaining some nerve function and is able to walk short distances with a walker. She can feed herself with assistive devices. Her tumour is malignant (they couldn’t get it all) and has multiple points of metastasis, primary unknown. Her primary and ER physicians and their staff were dismissive, disrespectful and neglectful. Her new team is collaborative, attentive and patient centred. Her journey is far from over, but she now feels heard with compassion. The reason for her “shallow” care should be explored.

  • Dr. Kathleen Ross says:

    Thank you Brandon for your insightful review of the competing pressures Physicians face both in and out of acute care. At times it does feel that we just need to step into your closet to think quietly. New models of team based care and new models of compensation to facilitate time for the deep work will require ongoing dialogue between physicians doing the work and those responsible for administering our precious healthcare dollars. You are off to a great start. Doctors of BC and all PTMAs across Canada are actively engaged in this work and we appreciate the voice of residents and new to practice physicians in this work. We are Better Together and will only succeed with collaborative leadership across silos.

  • Tim says:

    Wow, this encapsulates my residency experience in a nutshell. Thanks for verbalizing these thoughts! Must-read for any medical students and trainees interested in the healthcare system and the chaos of trying to get things done.

  • Sarah says:

    “There is inherent tension between the interwoven responsibilities of physicians: rapidly responding to urgent requests, quickly resolving large numbers of simple problems, all while vigilantly solving a small number of complex problems.”

    I have always thought about this concept. As an RN who sees my nursing colleagues page MDs multiple times in a day, sometimes even per hour, I’ve sometimes thought, “wow, how does anyone get any work done? Wouldn’t it make more sense to help work flow to batch our questions/ comments together?” But after being in this line of work for as long as I have, I’ve seen so many colleagues page throughout the day, almost as a stream of consciousness, and so it’s been normalized. I find it’s especially normalized in academic settings (versus community healthcare settings) when working with resident physicians. It’s interesting to see this perspective, thanks for sharing, but I guess my question is, what should we do then? Should we create physical and cultural spaces for deep work?

  • Olivier says:

    Doctors don’t work with automation the way pilots do.

    In as much as the aviation industry complains about distractions, I would argue that pilots are good at multitasking precisely because they make due despite the distractions. The order of priority is a very dynamic thing and therefore the necessity to adapt becomes a requirement.

    There is a thing called “task saturation” and it is usually where the flight becomes or can potentially enter an “undesirable state” and ultimately that can lead to an accident. That’s when “deep work” just doesn’t cut it anymore. Most aviation accidents happen during this time of “deep work” also called the approach and the landing phase, but they also happen when people are tired at the end of a long day or a long flight.

    We humans have limitations (and different kinds) and all industries have to learn what they are and how to place proper boundaries on them. The ability to absorb distractions and reprioritize in a timely and relevant manner is one of them.


Brandon Tang


Brandon Tang is a fifth-year General Internal Medicine subspecialty resident physician at the University of Toronto. Throughout his training, he has been engaged in education leadership and advocacy, including serving as Chief Resident for the International Conference on Residency Education and a deputy editor at Healthy Debate. He is currently pursuing a Master’s in medical education through Harvard Medical School. You can follow Brandon on Twitter at @DrBrandonTang.

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