Letters from Maine

Homework


 

How do you feel about homework? Do you think your school-age patients are given too much homework? Would they be better off spending their after-school time at home in free play or exploring nonacademic interests? Or, do you feel the school day is too short to adequately cover what a well-educated child needs to know? Doesn’t homework foster good independent work habits and discipline?

Do you have fond memories of doing homework? Are you glad those days of bringing home an hour or 3 of extra work are behind you? Maybe they aren’t behind you. Are you still spending an hour or more getting stuff done at home you didn’t get done in the office?

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If you are early in your career or even if you are a seasoned clinician, you are likely to still be doing homework. And you probably find it stressful. A recent survey of 1,200 early career pediatricians reported in an issue of AAP News (“What do early career pediatricians find stressful?”April 5, 2018) found that 52% of the respondents found “finishing/catching up with work from job at home” very or moderately stressful. Homework topped the list of stressors including staying current on medical knowledge (33%) and “providing care to children and adolescents (a reassuring 20%).

Primary care pediatrics has never promised its practitioners that they will arrive at home at the end of the workday free of unfinished business. If you have after-hours call responsibilities, there always have been phone calls, decisions to make, and trips to EDs and delivery rooms. Even if you are fortunate enough to not have after-hours call responsibilities, there are certainly evenings when you are nagged by second thoughts and worries about troublesome patients you have seen during the day. Did you make the correct diagnosis or forget to order a critical lab test?

This kind of homework is expected. It’s what you signed up for. But with experience, you learn how to provide better anticipatory guidance that can decrease the number of after-hours calls. You can minimize, but never eliminate, second-guessing by learning to make wiser diagnostic and therapeutic decisions.

However, arriving home with a laptop or notebook loaded with unfinished electronic health records and work-related emails is not what you thought primary care pediatrics was about ... and it didn’t used to be. For the first 35 years of practice, when I saw my last patient, my office work was over. If I wasn’t on call, I could enjoy the entire evening with my family uninterrupted.

But change happens. Coincident with the launch of a new computer system, my workday became an hour longer so that I could complete my electronic office notes before I went home. For some of my colleagues, this unwelcome addition ran more than an hour and a half or 2 hours, and many of them leapt at the practice administrator’s offer to link their home computers with our new office EHR. Buried in what sounded like a good deal to them, I could hear the creaky opening of a Pandora’s box.

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