by Frank Zadravecz, MPH
This story intrigues me, not so much its time-tested message on good versus evil, rather strangely its reflections on scientific inquiry. Robert Louis Stevenson paints the character Dr. Hastie Lanyon as a man committed to deductive reasoning and logic, conveniently the antithesis of Dr. Jekyll. After Lanyon witnesses Jekyll’s transformation from the grotesque Mr. Hyde, he makes this honest comment about pursuing knowledge: “I sometimes think if we knew all, we should be more glad to get away.”
Medicine challenges us to become physician-scientists along the life course of our study, but at times this duality feels unwieldy, similar to a rewrite where Jekyll, M.D. became Hyde, Ph.D. Our research findings may make perfect sense scientifically yet seem impossible to implement clinically. Our long held teachings might make for seamless clinical workflow yet lack the support of cruel, hard data. Physician-science tries to know the “all” of patient care, yet when we have exhausted the evidence available to us without solution, our cause can appear hopeless.
In my current research on alarm fatigue, I divide my time evenly between work in quality improvement and academic research. Until I began as an SHM Student Hospitalist Scholar, I naively assumed that these two fields were different in name only. I now recognize that each of the two disciplines chooses a unique starting point to investigate the “whys” behind patient outcomes. Quality improvement often follows a patient outlier down the rabbit hole of their clinical experience – exploring the reasons why someone becomes an emergency room frequent flyer, triggers more than their fair share of bedside alarms, or endures an inordinately long and expensive ward stay. Academic research in medicine compliments this aim of reigning in the extremes of adverse events in the hospital by focusing more broadly on mapping the road to a higher baseline in patient care.
Our alarm fatigue work highlights the balance necessary to navigate successfully between these two worlds. The more evidence we unravel from either the quality or research side of the physiologic alarm picture, the more difficult finding a viable solution to managing inpatient alarming seems. We are attempting to understand as much of Dr. Lanyon’s “all” as possible, without wishing that we had never started asking the “why” questions.
Frank Zadravecz, MPH is an alumnus of the Columbia University Mailman School of Public Health, a rising second year medical student at the University of Illinois at Chicago College of Medicine, and a Society for Hospital Medicine Student Hospitalist Scholar at the University of Chicago Medical Center. You can follow Frank on Twitter: @frankzadravecz