A different kind of health care crisis - physician burnout

[Pea-n-Me]

I posted this article on a different thread, but thought it was worthy of its own.

This one's by and about physicans, but I think examination of the same for other health professionals, especially nurses, who are providing most of the front line care as well as trying to keep up with the complexities of electronic medical record documentation, is not far behind.

https://www.bostonglobe.com/metro/2...ll:trending&s_campaign=bdc:globewell:trending

"Physician burnout has reached alarming levels and now amounts to a public health crisis that threatens to undermine the doctor-patient relationship and the delivery of health care nationwide, according to a report from Massachusetts doctors to be released Thursday.

The report — from the Massachusetts Medical Society, the Massachusetts Health & Hospital Association, and the Harvard T.H. Chan School of Public Health — portrays a profession struggling with the unyielding demands of electronic health record systems and ever-growing regulatory burdens.

It urges hospitals and medical practices to take immediate action by putting senior executives in charge of physician well-being and by giving doctors better access to mental health services. The report also calls for significant changes to make health record systems more user-friendly.

Medicine has become more regulated and complex over the past several years, generating what doctors often consider to be meaningless busywork detached from direct patient care. That’s when they start to feel disheartened, authors of the report said.

“A lot of physicians feel they are on a treadmill, on a conveyor belt,” said Dr. Alain A. Chaoui, president of the Massachusetts Medical Society and a family doctor in Peabody. “They’re not afraid of work — it’s the work that has nothing to do with the patients that makes physicians unhappy. And it makes the patients unhappy, because they feel the system is failing them.”

 

[Southernmiss]

I posted this article on a different thread, but thought it was worthy of its own.

This one's by and about physicans, but I think examination of the same for other health professionals, especially nurses, who are providing most of the front line care as well as trying to keep up with the complexities of electronic medical record documentation, is not far behind.

https://www.bostonglobe.com/metro/2...ll:trending&s_campaign=bdc:globewell:trending

"Physician burnout has reached alarming levels and now amounts to a public health crisis that threatens to undermine the doctor-patient relationship and the delivery of health care nationwide, according to a report from Massachusetts doctors to be released Thursday.

The report — from the Massachusetts Medical Society, the Massachusetts Health & Hospital Association, and the Harvard T.H. Chan School of Public Health — portrays a profession struggling with the unyielding demands of electronic health record systems and ever-growing regulatory burdens.

It urges hospitals and medical practices to take immediate action by putting senior executives in charge of physician well-being and by giving doctors better access to mental health services. The report also calls for significant changes to make health record systems more user-friendly.

Medicine has become more regulated and complex over the past several years, generating what doctors often consider to be meaningless busywork detached from direct patient care. That’s when they start to feel disheartened, authors of the report said.

“A lot of physicians feel they are on a treadmill, on a conveyor belt,” said Dr. Alain A. Chaoui, president of the Massachusetts Medical Society and a family doctor in Peabody. “They’re not afraid of work — it’s the work that has nothing to do with the patients that makes physicians unhappy. And it makes the patients unhappy, because they feel the system is failing them.”

Sounds just like complaints of teachers.

Sad that these professions are so regulated now that teachers and healthcare workers are frustrated with the 'extra' duties that it affects their care and instruction of patients and pupils.

But so many jobs today have layers of beurocracy that shade the real purpose of the job.

Even my husband yesterday was talking about the hours of training and classes now required of him in his federal audit job that have nothing to do with auditing.

I have to attend a training session next Saturday for my church office job that I believe will be useless, but it's now required by attorneys and insurance companies. I attended a session on the same subject in October of 2017 and can't imagine anything has changed since that meeting

 

[sam_gordon]

If the extra work (file keeping, etc) is what's bringing the doctor's down, couldn't they hire more help? Or take on less patients?

 

[Breezy_Carol]

If the extra work (file keeping, etc) is what's bringing the doctor's down, couldn't they hire more help? Or take on less patients?

The problem is that reimbursement from insurance is going down. One can't afford to take less patients or hire more staff. DH and I are both medical professionals and advised our kids not to go into health care. I was able to retire in October. (I turn 66 next month.) I couldn't take it any more. DH is trying to hold on a little longer but financially, it is tough. Health care is not what is was when we started in it.

 

[LSUmiss]

Sounds just like complaints of teachers.

Sad that these professions are so regulated now that teachers and healthcare workers are frustrated with the 'extra' duties that it affects their care and instruction of patients and pupils.

But so many jobs today have layers of beurocracy that shade the real purpose of the job.

Even my husband yesterday was talking about the hours of training and classes now required of him in his federal audit job that have nothing to do with auditing.

I have to attend a training session next Saturday for my church office job that I believe will be useless, but it's now required by attorneys and insurance companies. I attended a session on the same subject in October of 2017 and can't imagine anything has changed since that meeting

But also the bean counters have found a way to squeeze more money out of them by hiring less drs & less overall staff. On example, in most hospitals here, drs have to do their own charting. They use to do dictation & a secretary would do it. I have many friends who are doctors & I would never want their jobs.

 

[Ben E N]

Sounds just like complaints of teachers.

Sad that these professions are so regulated now that teachers and healthcare workers are frustrated with the 'extra' duties that it affects their care and instruction of patients and pupils.

But so many jobs today have layers of beurocracy that shade the real purpose of the job.

Even my husband yesterday was talking about the hours of training and classes now required of him in his federal audit job that have nothing to do with auditing.

I have to attend a training session next Saturday for my church office job that I believe will be useless, but it's now required by attorneys and insurance companies. I attended a session on the same subject in October of 2017 and can't imagine anything has changed since that meeting

As a teacher, I have to spend 20 minutes every year learning how hepatitis gets treated over months after exposure, as well as other information that has no worth to my job. A simple form for me to sign that says "I know blood is bad, and I will not touch it" would be much more efficient and effective.

 

[Happyinwonerland]

If the extra work (file keeping, etc) is what's bringing the doctor's down, couldn't they hire more help? Or take on less patients?

Many times, it isn't doctors who make staffing decisions. It is not the norm, at least in my area of the country, for physicians to have their own practices. Most are employed by larger healthcare systems (around here, Baptist, Catholic, and University systems reign), and they must abide by the rules given to them by their employer. They have to take on a certain number of patients and chart in a certain way, much of the autonomy has been lost.

As for healthcare worker burnout, it is a real problem. I've worked in healthcare for a decade, and it has changed so much over the last 5 years. The customer service model of healthcare, an increasingly aging population, and a rise in lifestyle factors that contribute to poor health have all caused strain on healthcare workers. Every shift I work, I am amazed at the sheer number of patients we care for. One local hospital is huge and has a large number of available beds, yet on any given day, they are overflowing, with some patients waiting on stretchers in a hallway for days before a room becomes available. ERs can't turn people away, yet the nature of the work makes it difficult to attract licensed professionals. Hospitals and staffing agencies around the country are offering $50-100/ hr for RNs and still can't get enough help, because everyone is just so worn out. Most RNs, myself included, are working on obtaining graduate and doctoral degrees to get away from the physical and mental stress of the bedside. Physicians suffer mental health problems and self harm at alarming rates. It is only going to get worse.

Our local Aldis and Costcos pay more per hour than CNAs, EMTs and Paramedics make.

 

[longboard55]

My response is we can not afford to spend anymore on healthcare. Its you industry, figure out how to make it easier. A real good start would to do more online and free up doctors from routine visits. The reason for the paperwork, is without it, the medical corparations would billing code us into bankruptcy

 

[jliehr]

I work for one of the big EMR companies, we work to improve outcomes for patients and improve efficiency in operations. It is immensely difficult to create a system for a large system, each practice has their own wants and desires (more customized means more things that can go wrong with changes or upgrades). Doctors are upset that systems are standardizing things and taking out individualism from their practice, but the goal is to use evidence from a greater population to provide more consistent outcomes for everyone.

The truth is we want cheaper healthcare and the outcome is greater patient loads, declining individual care and creativity. It will get worse before it gets better.

 

[seashoreCM]

Cut corners on some of the busywork paperwork to save time. Don't spend so much time deciding how you want to word something; just go ahead and say it even if it is more verbose than you might like. Don't spend lots of minutes checking the final text for spelling and grammar mistakes and fixing those. Did you know that exchanging two words in a computer document (the situation where you see a big sideways "S" encircling them) is much easier said than done?
Now you do have to get the facts (and the names of medicines) correct.

 

[Pea-n-Me]

I guess many of us slip up and still call what we do "paperwork". But it's not. It's entering information into an Electronic Medical Record (EMR). This is time consuming and unrelenting.

Here is a video that helps explain it better:

 

[longboard55]

They complain about paperwork, but want you to fill out the patient forms everytime you visit. put it all in a single data base that any doctor can see. my goodness such a basic idea, and they fight tooth and nail.

 

[Pea-n-Me]

Cut corners on some of the busywork paperwork to save time. Don't spend so much time deciding how you want to word something; just go ahead and say it even if it is more verbose than you might like. Don't spend lots of minutes checking the final text for little mistakes and fixing those.
Now you do have to get the facts (and the names of medicines) right.

Much of it isn't notes, it's checking boxes and pulling down menus. Many of them.

ETA from the article:

"much of the day is spent typing, pointing, and clicking in electronic health records, which are notoriously time-consuming and difficult to use. While doctors acknowledge that electronic records hold many advantages over paper charts, they say computers have become an obstacle — literally — that can hinder conversation with patients."

 

[gwynne]

Much of it isn't notes, it's checking boxes and pulling down menus. Many of them.

ETA from the article:

"much of the day is spent typing, pointing, and clicking in electronic health records, which are notoriously time-consuming and difficult to use. While doctors acknowledge that electronic records hold many advantages over paper charts, they say computers have become an obstacle — literally — that can hinder conversation with patients."

I know I really dislike talking to a provider that is 100% engaged in their computer screen. Read, click, type, click, click, type...repeat. I realize there are providers that don't like it either. I don't see it getting better.

 

[bigeyedfish]

Cut corners on some of the busywork paperwork to save time. Don't spend so much time deciding how you want to word something; just go ahead and say it even if it is more verbose than you might like. Don't spend lots of minutes checking the final text for spelling and grammar mistakes and fixing those. Did you know that exchanging two words in a computer document (the situation where you see a big sideways "S" encircling them) is much easier said than done?
Now you do have to get the facts (and the names of medicines) correct.

The notes that a Physician writes becomes a part of an electronic medical record. These notes are released to many different places for many different reasons. It would reflect poorly on the Physician and the clinic/hospital to have a poorly written, poorly edited chart note.

It seems many in this thread don’t work in healthcare or with EMRs.

 

[neverlandsky]

It’s not just healthcare, it’s education, retail, & food industry. It’s do more with less mentality. It’s generally less about the patient, student, and customer and more about meeting those required standards and technology to cut costs including payroll.

The burnout too is coming from not being able to leave work at work. With smart phones, you’re expected to be locked into work 24/7 including your PTO days. We might be physically working less then prior generations statistics wise, yet we’re mentally and emotionally working practicality almost all the time and even more due to technology.

 

[PollyannaMom]

Sounds just like complaints of teachers.

I was going to say the same thing! In both health care and education, the data is taking over. Sometimes I think more time is spent tracking what we do than doing it.

 

[sam_gordon]

It’s not just healthcare, it’s education, retail, & food industry. It’s do more with less mentality. It’s generally less about the patient, student, and customer and more about meeting those required standards and technology to cut costs including payroll.

I'd say it's not just healthcare, education, retail, & food, it's EVERYTHING. "Do more with less" means more profit. How do you change that though? Personally, I like the idea of the EMR some seem to be lamenting here. As a patient, I like being able to login to my provider's site and see my test results. As a patient, I like doctors/offices are able to send charts electronically.

So, for those that are lamenting the "paperwork", I wonder what your suggestions are to fix the problem (as you see it).

And those complaining about their doctors on their computers during the visit, that makes sense to me also. If they write on forms, then someone needs to later enter that into the EMR. Why not put the information straight into the EMR at the time?

 

[Pea-n-Me]

I'd say it's not just healthcare, education, retail, & food, it's EVERYTHING. "Do more with less" means more profit. How do you change that though? Personally, I like the idea of the EMR some seem to be lamenting here. As a patient, I like being able to login to my provider's site and see my test results. As a patient, I like doctors/offices are able to send charts electronically.

So, for those that are lamenting the "paperwork", I wonder what your suggestions are to fix the problem (as you see it).

And those complaining about their doctors on their computers during the visit, that makes sense to me also. If they write on forms, then someone needs to later enter that into the EMR. Why not put the information straight into the EMR at the time?

I'll take a stab at answering.

I'm not sure anyone is saying EMR is a bad thing, necessarily. The article and the video both talk about the obvious benefits, and most who use an EMR recognize it's a big improvement over paper records for lots of reasons.

I believe this is the first time I've noticed anyone "complaining" about anything like this. Formally, anyway.

And I don't think it's so much "complaining" as it is being proactive and saying, "Hey, we're seeing an increased amount of burnout and stress over the last few years - much more so than usual - and we think it's related in large part to the introduction of EMR into our practices. We feel we need to address it because people are experiencing many negative effects of burnout, and even leaving jobs and such due to the increased stress, so we feel we need to more closely take a look at this in our profession".

I see it in large part, as this. A lot of us went into the helping professions to, well, help people. We're "people people", and enjoy the aspect of our positions that interact with patients and listen to their concerns, speak to them, educate them, talk to their families, maybe give them a hug or hold their hands, etc. "Bedside manner" and all that. We didn't go into it to work primarily in a computer screen, and it frustrates us that this has become such a large part of our jobs. And there's no getting away from it, ever. This is it now.

In the article it said:

"Doctors typically spend two hours on computer work for every hour they spend with patients"

I believe that translates on a typical nine hour day into: Six hours of computer work for three hours of patient care.

These systems, for many places, have been relatively newly implemented, and can be extremely complex to use. So it's not like providers can always just plug away quickly at their computer work. It can be an exercise in frustration trying to figure out where to document something, especially with the pressure that's always there knowing you HAVE to figure it out in order to comply with the many regulations before them in re: health regulations and billing, and someone will be along to audit, etc. It's never-ending and new initiatives are thrown at them all the time, requiring more and more of their time away from patients, which makes both providers and patients unhappy. It's just not what many people "signed up for" when they joined their profession.

Perhaps younger generations of providers will find it easier to meld patient care with EMR documentation as they've likely grown up in the electronic age and will know going into it that this is how it is. But for many others, it can be a source of great stress on the job. That is all they're saying. I don't have answers other than what they've suggested in the article with having people around to help, indeed, concentrate, on employee wellness, and perhaps better technology support. I don't feel that hiring more help will always be an option, nor will taking less patients on, as the name of the game seems to be not turning anyone away that needs care.

It is good to discuss it, not just for those currently in the professions or considering leaving, but for those who might be thinking about going into them.

 

[marcyleecorgan]

With our general population aging at a massive rate, this isn't going to get ANY better sooner....