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].
The goal of the game is to be the Doctor that gets to fill the shoes of the soon to retire head of medicine at the hospital. The entire game is structured around attempts to thwart your rivals and place them in situations that may lead to them being suspended, fired or even killed! The game will run over one or more sessions, but a one off is recommended due to the nature of the game. 
At any point where a player has lost their primary character they will be assigned another role by the Head of Medicine (GM). This will likely be the role of a hospital administrator, a patient or some form of external official who is there to audit and investigate Doctors for Malpractice. 
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. These systems will be used by you to try and manipulate yourself to the top of the pile for promotion. 
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: Lead by the Head of Medicine
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.

Setting up your Hospital
I.	Staff
Draft up a brief structure of the staff at the facility. This should look like a standard organisational chart. A flow diagram with a hierarchy of management, Doctors, Admin, Nurses and the departments they are assigned to. 

Just put the title in each person’s box, you can fill out names as players pick roles and as players meet other staff and interact with them. Each of the NPC boxes will have a brief overview of the personality and a few statistical traits to help guide the Head of Medicine (from now on referred to as the HM). Below is a very brief of example of that a part of your chart might look like. 

As you can see the NPCs have a list of brief stats to give you a guide to how the might react to people and situations. A few words should be added to flesh out their personalities. 
Prof Michaels
Bored, scathing, witless and addicted to ADHD medication. 

II.	Hospital grounds. 
A brief sketch of the premises and surrounding grounds would be useful. This can be filled in as you go along with departments being named and added as they are encountered. I fully encourage you to colour you sections of the map, so you can easily see what departments are linked to different players. 
Perhaps employ a traffic light system in each section so you can tell at a glance which sections are running well, doing okay and which are under investigation or on notice. 
I also encourage petty things like allocating parking spaces to different players based on in game performance at the hospital. It might be petty having one player unable to park at work and having to park off site. But that is the nature of the game!

III.	Plot
A lot of the game should be driven by patient demand and players attempts to thwart each other, have difficult patients transferred to another Dr and general backstabbing and office politics.
However, I fully recommend adding a twist that the players have no idea about at the start of the game. The introduction of a patient who is a paranormal investigator undercover, a haunting, a secret cult, the leaking of patient psyches in to Doctors and any other case that would cause stress, provide opportunity for players to try and work together, but still ultimately aiming to knock out other people from the HM post. 
I feel that subtle creepiness is in order here. Things that freak out the players and make them very uncomfortable. Like shared nightmares between characters, patients and staff. Interactions between players that have unwanted side effects. Such as mid conversation interrupting your players to ask one of them to voice their characters true feelings about the person they are talking too, play it out as a glimpse someone has in to another person’s mind, bleeding over thoughts and causing mistrust and anxiety. 
Perhaps you have told them the objective of the game is to become HM, but in fact there is something profoundly disturbing going on and see if the players can overcome their need to win, and work together to just survive. 
Maybe even having one of the players aware that something not right is going on from the start and throw them a red herring to see what they do with it. 
IV.	Mechanics
The game resolution should involve opposed rolling, or card playing from a hand with situational modifiers. Opposition is the key to this game, having players at odds with and stressing the opposition through the game mechanics will subconsciously lead players down a road of further conflict. 
A mechanic that reduces available cards, or reduces dice pools or gives modifiers based on stress levels is completely encouraged. As is one where abuse of drugs and alcohol negates some of these issues. As the session progresses everything should get harder, Doctors should get worn down and barely be able to cope with work, pass tests or skill checks without resorting to the temptation of alcohol or drugs to mitigate the difficulty. Those that do chose to abuse, should initially receive substantial bonuses, to encourage other players to take on a similar approach to coping with stress and anxiety. Make it look like a good thing, never discuss the negative consequences of their actions until it is too late. 

References
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