Tag: Burnout

Healthcare Has a Moral Injury

Feb 13, 2020• 1

By KIM BELLARD

The term “moral injury” is a term originally applied to soldiers as a way to help explain PTSD and, more recently, to physicians as a way to help explain physician burnout. The concept is that moral injury is what can happen to people when “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

I think healthcare generally has a bad case of moral injury.

How else can we explain physicians practicing surprise billing, hospitals suing patients, health plans refusing to pay for pre-authorized treatments, or pharmaceutical companies charging “skyrocketing” costs even for common, essential prescription drugs? There are people involved in each of these, and countless more examples. If those people haven’t suffered a moral injury as a result, it’s hard to understand why.

Melissa Bailey, writing for Kaiser Health News, looked at moral injury from the standpoint of emergency room physicians. One physician decried how “the real priority is speed and money and not our patients’ care.” Another made a broader charge: “The health system is not set up to help patients. It’s set up to make money.” He urged that physicians seek to understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Burned out on Burnout?

Feb 12, 2020• 1

By SANJ KATYAL, MD

If you are like most doctors, you are sick of hearing about burnout. I know I am. There is a big debate on whether burnout is real or whether physicians are suffering from something more sinister like moral injury or human rights violations. That doesn’t matter. In the end, no matter what name we give the problem, the real issue is that physicians are in fact suffering. We are suffering a lot. Some of us—around one physician per day—are forced to alleviate their suffering by taking their own life. Each year, a million patients lose their physicians to suicide. Many more physicians suffer in silence and self-medicate with drugs or alcohol in order to function.

We are losing more physicians each year to early retirement or alternate careers. There are an increasing number of coaches and businesses whose single purpose is to help doctors find their side gigs and transition out of medicine. This loss comes at a time of an already depleted workforce that will contribute to massive physician shortages in the future. Perhaps even more troubling is that those physicians who remain in medicine are often desperate to get out. It is the rare physician these days that recommends a career in medicine to their own children. We now have a brain drain of the brightest students who would rather work on Wall Street than in a hospital.

As a physician trained in positive psychology, I have been committed to helping other physicians and students improve their well-being. The focus on well-being is a welcome change in medicine. But is it enough?

Revisiting the Concept of Burnout Skills

Dec 30, 2019

By HANS DUVEFELT, MD

I looked at a free book chapter from Harvard Businesses Review today and saw a striking graph illustrating what we’re up against in primary care today and I remembered a post I wrote eight years ago about burnout skills.

Some things we do, some challenges we overcome, energize us or even feed our souls because of how they resonate with our true selves. Think of mastering something like a challenging hobby. We feel how each success or step forward gives us more energy.

Other things we do are more like rescuing a situation that was starting to fall apart and making a heroic effort to set things right. That might feed our ego, but not really our soul, and it can exhaust us if we do this more than once in a very great while.

In medicine these days, we seem to do more rescuing difficult situations than mastering an art that inspires and rewards us: The very skills that make us good at our jobs can be the ones that make us burn out.

Doctors are so good at solving problems and handling emergencies that we often fall into a trap of doing more and more of that just because we are able to, even though it’s not always the right thing to do – even though it costs us energy and consumes a little bit of life force every time we do it. And it’s not always the case that we are asked to do this. We are pretty good at putting ourselves in such situations because of what we call our work ethic.

Health 2.0: Why I’m (Freaking) Excited…and a (Bit) Concerned

Sep 20, 2019

By DAVE LEVIN, MD

The 2019 Health 2.0 conference just wrapped up after several days of compelling presentations, panels, and networking. As in the past, attendees were a cross section of the industry: providers, payers, health IT (HIT) companies, investors, and others who are passionate about innovation in healthcare.

Tech-enabled Services

One of the more refreshing themes of the conference was an emphasis on how health IT can enable the delivery of services. This is a welcome perspective as too often organizations believe that simply deploying technology will solve their problems. In my 30+ years in healthcare, I’ve never seen that work. What does work is careful attention to the iron triad of people, process, and technology. Neglect one of these and you will fall short of your goals. Framing opportunities as services that are enabled and enhanced by technology helps us avoid the common pitfall of believing “Tech = Solution” and forces us to account for process and people.

Provider Burn-out and Health IT

Several sessions focused on the impact technology is having on end-users, especially clinicians. One session featured a “reverse-pitch” where practicing physicians “pitched” to health IT experts on the challenges they face, especially with EHRs, and what they need in order to do their job and have a life. This was summed up elegantly by a physician participant as, “Please make all the stupid sh*t stop!” There’s increasing evidence that the deployment of EHRs is a major factor for clinician burnout and the impassioned pleas of the attendees resonated throughout the conference.

Other sessions explored how to we might address these problems with improvements in user-interface design, workflow, and interoperability. Demonstrations of advanced technologies like voice-driven interfaces, artificial intelligence, enhanced communications, and smart devices show where we are headed and hold out the promise of a more efficient and pleasing HIT for providers and patients.

Healthcare IT Has Failed Providers, but It’s Not Too Late to Redeem Ourselves

Aug 1, 2019• 4

By GUS MALEZIS

It’s no secret that healthcare providers are among the hardest working of all professionals – their skill and intelligence are matched only by their creativity and commitment to their patients. But the healthcare IT sector, while it has made an effort to assist, has failed to support our providers – doctors, nurses and caregivers – with technology solutions that meet the increasing demands for better, faster, more efficient patient healthcare delivery. Instead, we have cast these providers in the dark, forcing them to function blindly, devoid of necessary information, pushing many of them to the brink of what they can withstand as professionals, pushing them to burnout.

The thing about providers is that, in addition to being hardworking, dedicated, and outstanding professionals, they are incredibly creative and innovative, willing to embrace new technologies and workflows – as long as they can add value to their patients. So how about we – the broader healthcare IT solutions vendor community – focus on delivering technologies that don’t force them to compromise care and efficiency for the sake of security, or compliance and access to data?

We need to do so to address an industry crisis. Physician burnout is on the rise, and it’s increasingly clear that overworked providers have reached the breaking point. They spend valuable minutes battling technology on virtual desktops, mobile devices, biomedical equipment, and clinical SaaS applications – typing in usernames and passwords, loading various apps, and more. All the while, standing beside a patient that is desperately seeking their assistance.

Right now, nearly one-half of all physicians (44 percent) report having feelings of burnout (according to Medscape‘s 2019 National Physicians Burnout & Depression Report). While these numbers should alarm everyone, what the healthcare IT industry should be especially concerned about is that a leading cause of this physician burnout are tools that hinder provider productivity. Instead of simplifying work for doctors and nurses, technology tools are having the opposite effect. Isn’t technology supposed to make things easier?

Coaching and Leadership Training Can Help Med Students Avoid Burnout

May 20, 2019

By MARGARET CARY, JACK PENNER, and JP MIKHAIE

Burnout is one of the biggest problems physicians face today. We believe that addressing it early — in medical school — through coaching gives physicians the tools they need to maintain balance and meaning in their personal and professional lives.

We say that after reading comments from participants in our coaching program, “A Whole New Doctor,” developed at Georgetown University School of Medicine. This program, born almost by chance, provides executive coaching and leadership training to medical students, who are exactly the right audience for it.

Medical students tend to begin their education as optimistic 20-somethings, eager to learn and eager to see patients. After spending one or two years on the academic study of medicine, they move to the wards where they observe the hidden curriculum — a set of norms, values, and behaviors conveyed in implicit and explicit ways in the clinical learning environment.

In the hospital, convenience and expediency, deference to specialists, and factual knowledge tend to replace the holistic and patient-centered care that is lauded during the preclinical years. This new culture nudges some students to the brink of burnout and depression. Some consider suicide.

How To Prevent Burnout. Frederick This One.

Aug 24, 2017• 1

By MARTIN A. SAMUELS

I posted an essay on The Health Care Blog entitled The Prevention of Physician Burnout: A Nine Step Program. Here is an example of how this works. Recall the wonderful children’s book by Leo Lionni, Frederick. Let me remind you of it.

A family of mice begins to store away food and supplies for the long winter ahead. Most are practical and gather corn, grains, and straw. One of the mice, Frederick, instead collects rays of sun, colors of the rainbow, and words to remember. When winter arrives the family begins to use up their practical supplies. They become irritable and angry and don’t have anything to talk about. In other words, they become burned out. Frederick shares his stores of sun rays, colors, and a poem which enlivens their spirits and saves their lives.

Ever since reading this story to my own children I have used Frederick as a verb. When a wonderful event occurs, I try to remember to Frederick it…….and save it for a tough day.

About a month ago, a 20 year old woman, previously completely healthy, began to experience twitching of her left hand. Over several days this involuntary jerking worsened and spread to involve the left side of the face as well. Her parents told us that her personality had dramatically changed in that she lost her usual ebullient nature and became almost inert and unreactive. She came to us where it appeared that she was suffering from epilepsia partialis continua (continuous partial seizures).

The MRI was very abnormal in that it showed a very bright signal on T2 weighted images in the basal ganglia bilaterally. An EEG was abnormal in that it was quite slow, but there were no definite cortical correlates to the jerking. Continue reading…

Death By Documentation

Jul 11, 2015• 2

DIKE DRUMMOND, MD

In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress.

In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.

1. EMR – especially if you use multiple EMR software programs that don’t talk to each other

2. Dealing with lab reports and refill requests

3. Returning patient and consultant calls and documenting them adequately and all the other places information streams have to be forced together by the sweat of your brow.

The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.

How much more time will ICD-10 take?

Lost in the Health Care System?

Jun 4, 2014• 76

Jack Cochran

By Jack Cochran & Charles Kenney

“As a PCP, I’ve seen the morale in my area, and I see a major crisis coming if the complaints are ignored.”

“I’ve lived in the hell that is American health care…”

A devoted physician wrote these words in reaction to a recent blog post we wrote. And he is clearly not alone.

In our new book The Doctor Crisis, we report on the widespread unhappiness, frustration, dissatisfaction, and anger of so many American physicians.

We believe this crisis is real and growing; that it is an impediment to providing the care the American people need; that dealing with the doctor crisis is fundamentally patient-centered; and that the crisis has not been recognized for the fundamental threat it poses.

Our recent feature on The Health Care Blog elicited some powerful reaction:

Rob: ”In a certain sense, individual doctors ARE victims of a system that rewards over-consumption, ridiculous documentation, attention to codes over people, and bureaucracy over partnership…”

Jeff: “Can validate what Rob has said. I’ve spent the last three years listening to physicians about the possible alternative futures for their profession, and the overwhelming desire was exactly as Rob said- an overwhelming impulse to flee…”

Some commentators wrote that doctors shouldn’t complain because they earn a lot of money, drive fancy cars and own nice homes. But that theme – accurate in many cases but certainly not all — gets us nowhere.

We think the rubber meets the road with this warning from Dr. Rob, ”…As a PCP, I’ve seen the morale in my area, and I see a major crisis coming if the complaints are ignored.”

Is Dr. Rob overstating it? We don’t think so. In fact, we think he has it exactly right. How can our system function properly if the level of job satisfaction among doctors continues to spiral downward?

Harris Interactive research describes the profession as “a minefield’’ where physicians feel burned out and “under assault on all fronts.’’ Has such extreme language ever been used to characterize the medical profession? Have doctors ever faced a time as turbulent as this?

Doctors are certainly not blameless as both Brian and Rob noted in their comments:

Brian: “…I’m concerned that you have framed your argument as though physicians are victims of the system rather than partial drivers of its characteristics …”

Rob: “…physicians as a group have been complicit in building this system, and so should bear a lot of the blame…”

So what needs to be done?

A crucial first step is for health care stakeholders to recognize and acknowledge the existence of the crisis. Doing so will get the doctor crisis on the national health care agenda. Unfortunately, the matter is not currently a priority for many, if not most, provider organizations. That needs to change.

Tending to the Health Care Workers of America

May 27, 2014• 12

By Timothy Hoff

Given the attention now paid to implementing national health reform, the bulk of which is now upon us as 7 million new individuals now have health insurance, one important issue remains largely ignored by policy makers and industry leaders–health care workers are very unhappy.

A 2012 national survey of 24,000 physicians across all specialties found that if given the choice, just over half of these doctors — only 54 percent — would choose medicine as a career again. Fifty-nine percent of physicians in a 2013 survey could not recommend their profession to a younger person, and forty-two percent were dissatisfied in their jobs. Forty percent of physicians in another 2013 national survey self-identified as burned out.

Nursing has gained the moniker of one of the least happy jobs in America, with nurses traditionally experiencing high rates of job dissatisfaction, burnout, and turnover. Some of the reason for this malaise among our highest status health professionals has to do with the stressful, uncertain nature of health care work.

But it also is an outcome of the everyday worlds in which all health care workers now find themselves: a world drenched in paperwork, packed patient schedules, and decreased control. In short, the new world of health reform.

We are in the midst of a technological and business revolution in health care delivery. We are also on expanding patient demand in ways not seen in generations. But we are not meeting the needs of health care workers, who are expected to produce at a higher level than ever before.