What is a Workin?

There is this phenomenon commonly encountered in the resident clinic. It's called the workin. A workin is a patient who wasn't on the schedule at the start of the day and was later added for whatever reason. Much like everything else, workins typically get inappropriately dumped on the resident clinic.

You see, there is one huge advantage to academic medicine - office time. In all honesty, I can't wait for it. But at any rate, it is time dedicated for an attending to be able to work on administrative or research duties. And the reality is, it not uncommonly amounts to time spent away from work - a time when you are essentially unavailable. Again, I can't wait for this -  I would likely do the same. The exception comes when you're talking about program directors and department heads.

But as residents we feel the brunt of it at times. Suppose a patient of Dr. Azulweebum comes with a complaint of some sort. In the private world, that patient would be put in Dr. Azulweebum's clinic. And if Dr. Azulweebum was absent, and as long as the patient's issue wasn't dire emergency, the patient would just be told to come back to her next scheduled clinic. Not at JEI. Patients get worked in left and right because that's the JEI policy - see all who come in. And there's a lot of office time to be had. But a line has to be drawn.

The other day, one of Dr. Azulweebum's patients needed an exam to renew her contacts. See, without a complete annual eye exam, most contact suppliers won't renew your contact prescription - as it well should be. So Dr. Azulweebum's primary tech, in her infinite wisdom, decided to work her in to my clinic which was already full, and I the only resident. Did anyone ask me if this was okay? No. Did anyone ask the attending if this was okay? No. And I can guarantee that if she had asked, the answer from either of us would have been the same: No.

This does not qualify as a work in. If you need your annual eye exam to renew your precious contact prescription, you can schedule an appointment with your regular Dr. Azulweebum just like everyone else. A workin should be limited to urgent issues, not to include patients who are four hours late or need their glasses fixed (which happens at JEI).

But no one ever asked me. Or Dr. Azulweebum.