Doctors, Stress, and Outcomes: 
A Revised Model and Role-Playing Game

Abstract--The objective of the following role-playing game (RPG) is to portray doctors on the edge of psychosis. Subjected to social stressors (such as meetings, infighting, and competition) and asked to perform difficult tasks (such as performing surgery, managing many patients, and dispensing powerful drugs), their world begins to unravel. This world is a work of fiction. This world contains gross exaggerations and downright lies about how medicine works. This document should not be considered anything more than entertainment. Harsh language, sexual deviance, and drug use are discussed with little subtlety in what follows. Please do not read further if you are young, humorless, or unfamiliar with the concept of willing suspension of disbelief.

Keywords: 
Trial 1547
I.	Background
At present, a great deal of stress is placed on practitioners within the medical profession; few have it worse than doctors. Doctors must navigate a complex, high-risk environment using their physical, mental, and social competencies. They benefit from a great deal of training; however, doctors have noted that no amount of training could be considered sufficient [1]. Psychological maladies are known to arise (or be exacerbated) during periods of particularly high stress [2]. Many doctors turn to drugs (ill-advised though this is) in an attempt to gain control over their situation; however, the outcomes are often fatal [3].
II.	Purpose
The objective of the present research is to present a Kafkaesque (or Orwellian) model of the daily lives of doctors in extremely stressful situations and to turn this chaotic system into a game.
III.	Methods
Each doctor is possessed of several competencies. They are listed below. Tasks labelled “Convince” are methods of convincing people. Once one kind of Convince task has been used, it is unlikely that any of the others will work on a given person.
A.	Physical, Mental, and Social Competencies
There are three types of task: physical, mental, and social.
a.	Physical tasks
Intimidate – (Convince) Compliance can sometimes be coerced. In this task, the doctor intimidates the patient into compliance.
Push yourself – This task indicates an attempt to push the physical limits of speed, strength, or endurance. 
Subdue – Sometimes intimidation is ineffective. In this task, the doctor wrestles with the patient, in an attempt to prevent injury to all involved.
Steady hand – In this task, the doctor attempts to perform a delicate and/or complex hand movement. Good for surgery, giving injections, and stealing documents.
b.	Mental tasks
Several tasks rely on the wits, knowledge, and memory of the doctor. These tasks are as follows:
Use jargon – (Convince) Drawing from the depth of knowledge acquired during years of medical training, the doctor begins to list off technical terms. Sometimes there’s no better way to get compliance from a patient than to show off.
Write a script – Selecting the correct medicine and dosage or accurately transcribing an event is not always easy. In this task, the doctor attempts to put a diagnosis, prescription, or report to paper.
Give it to 'em straight – In this task, the doctor conveys the seriousness of the situation. Informing a loved one of a botched operation can be difficult.
Interpret an omen –In this task, the doctor attempts to divine the importance or meaning of a small, subtle detail.
c.	Social tasks
Several tasks rely on the kindness, bedside manner, and guile of the doctor. These tasks are as follows:
Create an emotional connection – (Convince) In this task, the doctor attempts to convince the patient using some kind of shared emotional state.
Take a history – An accurate history is the key to accurate treatment.
Read a person – Sometimes, people lie. In this task the doctor attempts to discern the truth.
Cover – Sometimes, you get caught. The doctor can use this task to attempt to construct a cover story.
B.	Specializations
a.	Immunology/infectious disease
b.	Oncology
c.	Cardiovascular
d.	Gastroenterology/Hepatology/Nephrology
e.	Psychiatric
f.	Plastic surgery
C.	Aptitudes
a.	Diagnostics
b.	Treatment
c.	Surgery
D.	The Effects of Rest
E.	The Effects of Stress
High stress results in perversions of desire (in which something normal is taken to an extreme) and the use of drugs, as a coping mechanism.
a.	Perversions of desire
i.	sexual deviance (perversion of love)
Inappropriate arousal. Fantasizing. Lewd comments. Misunderstandings. Beware the inevitable lawsuit.
ii.	alcohol (perversion of calm)
iii.	coffee (perversion of enthusiasm)
Grogginess. Lethargy. Jitters. Heart palpitations.
iv.	holiday (perversion of rest)
Vivid daydreams about the destination. Money worries. Arguments with spouse or friends as to destination/details. Arguments and misunderstandings with administration about taking time off.
v.	death (perversion of existentialism)
Vivid daydreams about death. Confusion about whether a patient is alive or dead. Flashbacks. Nightmares.  
vi.	art/entertainment (perversion of aesthetics)
vii.	sleep (perversion of natural rhythms)
Sleepwalking. Vivid daydreams about falling asleep. Lucid dreaming. Falling asleep during the day. Night terrors.
viii.	slights (perversion of community/respect)
ix.	rage (perversion of control)
b.	Drug use and side effects
i.	Stimulants
Boost physical at the cost of mental.
ii.	Depressants 
Boost mental at the cost of physical.
iii.	Hallucinogens
iv.	Tranquilizers and painkillers
v.	Synthetic hormones
vi.	Mood stabilizers and antipsychotics

IV.	Results
A.	Confrontations
A confrontation occurs whenever a doctor is dealing with a high-stakes situation, from surgery to a coffee-break chat with the head of the department. Roll some dice here…
B.	Outcomes
a.	For Patients
Doctors begin with six active (major) patients in their patient pool. Patients can die, can request another doctor (called “second opinion”, although this can be a euphemism for any kind of misconduct), or can be released after successful treatment (see the following subsection). In all cases, the pool of patients will slowly be replaced. In the case of mistakes leading to death (or sometimes, “second opinion”), an investigation will often be launched.
b.	For Doctors
Once a doctor’s patient pool is reduced to zero, the doctor is put on administrative leave. For the purposes of the game, this doctor is no longer considered. Once all doctors have been put on administrative leave, all patients that were released after successful treatment are tallied. This score indicates the doctor’s chances in the upcoming malpractice lawsuit. 
C.	Hierarchy of the Hospital
a.	Government and public opinion
b.	Hospital administration
c.	Head of the department
d.	Other doctors
e.	Nurses
f.	Patients

V.	Conclusions
I hope that people can have fun with this game. Additionally, I hope they can enjoy it in the spirit in which it is intended: flippant, surreal, and scathing.

References
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