Blog | Tuesday, February 23, 2016

Can physicians take vacation?

Years ago, I was having dinner with 2 members of The Cleveland Orchestra, one of the finest orchestras in the world. I asked them, with my kids present, how much time they devoted to their craft. As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom. The musicians told us how much time they practiced, which was mind boggling. Any artist or athlete or Green Beret or similar professional, has to demonstrate extraordinary commitment to maintain a superlative level of excellence and preparedness. Every day.

I asked one of the musicians, the violinist, how long he could stay away from playing his instrument before he noted some professional slippage. Guess your answer. At the end of this post, I will relate his reply.

How long can you be away from your job before your performance ebbs?

For most of us, we can take weeks or longer on holiday and return back to our positions seamlessly.

A few examples.
• politicians return to Congress after long breaks and lose not a whit of their skills of obfuscation and duplicity,
• New York City cab drivers return from vacation and can make their first passenger's heart stop without missing a beat,
• an airline customer service representative a few continents away maintains state-of-the-art client service even after a month away from her cubicle.

What about doctors? What about gastroenterologists?

Yes, I do take vacations, but most of them are long weekends. I took 5 days off in a row last August. Now that my kids are grown, I have taken a few longer vacations, but during the most of the past 2 decades, my times away from home have been brief outings. Perhaps, the reason why I maintain such a keen colonoscopy edge is because my absences have been brief. If I took a sabbatical for 6 months, would I be rusty when I approached my first rectum on my return?

I will admit that manipulating a colonoscope, when I bring light into a dark world, is not exactly the same as playing a violin in the Cleveland orchestra. I'll leave it to the reader to contemplate which of these takes more skill.

Seriously, do physicians lose their cognitive and procedural skills after a period of time? I'm not sure this has been tested, but I believe the question is a reasonable one for patients to consider. Hospitals track volume of surgeries from specific surgeons, but a busy surgeon could meet the yearly threshold, which might be modest, and still take several months off. Should a patient who is to undergo a cardiac bypass or a colonoscopy after the physician has been away for a few months be concerned?

Is medicine like riding a bicycle that one can do well after a hiatus of years or more? Or should doctors who have been off the bike for a while put some training wheels back on?

Consider this the next time you are hearing music from a master musician. One thing is for certain. (S)he hasn't been on the beach. The violinist I queried told me that he if doesn't practice for 3 days that he is below par. Would you like to have a job like this?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.