Editorial: Regaining your focus

September 1, 2005

By then, of course, my young listener's eyes had glazed over. With a deep sigh, she reminded me that she wanted to know which task was most difficult, not what my job entailed. As my mind raced from job to job, problem to problem, and crisis to crisis, the answer became obvious: focus! "It's the 'Bridge on the River Kwai' syndrome," I said, prompting a puzzled look from my listener.

Readers with few gray hairs may not recall the movie "The Bridge On the River Kwai," which was directed by David Lean, starred Alec Guinness and Sessue Hayakawa, and was released in 1957. This Academy Award-winning film tells the story of a martinet British colonel named Nicholson, who is pushed to the physical and emotional breaking point in a Japanese prison camp. The colonel, in turn, breaks the spirit of his honor-bound Japanese commandant, who is desperately trying to get the starving British prisoners to build a railroad bridge across the River Kwai. Faced with a looming deadline, the Japanese commandant grants Nicholson's demand to have his experienced British military engineers redesign the bridge after offering a harsh critique of the original Japanese design. By the end of the movie, Colonel Nicholson is openly elated at the magnificent bridge his soldiers have built for the enemy, while the Japanese officer is so ashamed of being psychologically bested that he contemplates suicide. The point of the story is that we can become so wrapped up in our complicated and stressful lives that we lose focus. We forget why and for whom we are building the bridge.

Management experts call the juggling act performed by ob/gyns "focus change mode."1 We direct our attention at a specific problem for only a short while. Over time, we stop really thinking about the problem at hand and begin responding superficially and reflexively. When a situation is acute and challenging, we summon up our catecholamines and by dint of stamina or a burst of energy, we resolve the challenge with not so much as a backward glance to reflect on what we've learned from our harrowing experience. Some people actually get hooked on these adrenaline rushes.

The real problem with focus change mode is its inevitable negative impact on an ob/gyn's performance. Most of us don't have the luxury of spending hours focusing on a complicated patient, assembling all the pertinent facts and reviewing all the latest literature. Instead, we simply do what we remember we did when last faced with a vaguely similar problem. If we're lucky, only patient satisfaction will suffer because of our inattentiveness, but sometimes, patient safety is at stake. Regardless, practicing on the fly doesn't help job satisfaction.

Operating in focus change mode can also lead to bad business decisions, like accepting a managed-care contract that loses money on each patient seen, or ordering an $85,000 ultrasound machine when a rehabbed one for $20,000 would do just as well. And then there are the consequences on the home front. Focusing on a clinical problem to the exclusion of one's anniversary can be very painful and costly.