How Hospitals Think They Can Fix Burnout
I know that many of you cannot read this article in the Wall Street Journal but I still think there is a need to highlight what was said in it. The online version is called:
Hospitals Address Widespread Doctor Burnout
To address an epidemic of physician stress that some say puts patients at risk of medical errors, hospitals are making changes
Okay, where do I begin? First, I need to take a deep breath. Look at the sub headline. Patients at risk? Medical errors? Umm, what about doctors killing themselves or quitting? To be fair, at least this issue is being talked about. Let’s move on.
The article highlights how some hospitals are creating a new position called “Chief Wellness Officer”. What’s your thoughts when you first hear that? I hate that more administrators are created but I do like that someone is going to bat for the doctors. Anyway, the doctor doing this job was interviewed and said this:
“Telling doctors to eat granola, do yoga and be more resilient isn’t going to address this problem,” says Tait Shanafelt, who was appointed chief wellness officer of Stanford Medicine a year ago.
Ok, he gets a pass on this because I think he is right. The rest of the article talks about things I have been saying FOREVER:
- One priority is reducing clerical duties. A leading cause of physician distress is electronic record-keeping, which requires doctors to do clerical and billing work, and cuts into time with patients. It has also increased “Pajama Time,” the hours doctors devote at home to electronic charting that wasn’t finished during the day.
- A related problem is managing electronic in-baskets filled with patient demands. “A typical physician nowadays gets bombarded with tasks.”
But the recommendations given were questionable:
- He envisions a team approach where doctors focus on clinical care and leave some tasks to others. By shaving administrative minutes here and there, Dr. Ripp aims to reduce nightly electronic work by an hour.
- Hiring staff to sit in on appointments and take notes is cost-effective, he says, because it frees up doctors to see more patients.
The answer, in my humble opinion, is not hiring more people but destroying the system that created these tasks in the first place. Direct primary care is one way but I understand that this may not work for specialists. We cannot keep trying to follow the demands of third parties and think we can win at this game. That is a dog trying to catch his tail. This system needs to be blown up. The bandaid approach won’t work.
My favorite part of this article, and I am not being sarcastic, was this:
As an example of frayed bonds, Dr. Shanafelt points out that hospitals’ physician lounges, where doctors could meet, unwind and discuss cases, have largely vanished. While two new Stanford hospitals have them, Dr. Shanafelt, associate dean at the Stanford School of Medicine, would like gathering places for doctors throughout his institution and at other hospitals as a low-cost effort “to help drive community.”
I love the idea of a Doctor’s Lounge again!! Love it. But who would be allowed in? Doctor of what? DNP? Ph.D? There is no way this would hold. I could see this politically correct culture of ours watering that down so much that ANYONE would be allowed in and then doctors wouldn’t show up anymore. And then the administration would close it. Oh yeah, that is how they got rid of them in the first place.
What is your thoughts on all this? I would love to hear it.
(Get our action packed newsletter by signing up here. We don’t give your email out and we don’t spam you.)
How bout fire at least half the administrative staff, go back to paper records with concise notes (hire somebody to massage said paper notes into whatever drivel needed for payment..could be a job for some of those former administrators) and bring back the doctor’s lounge. No midlevels or any other damn thing, just doctors. Let the midlevels have kale and crystals somewhere else.
I disagree with you on this point, Doug:
“I love the idea of a Doctor’s Lounge again!! Love it. But who would be allowed in? Doctor of what? DNP? Ph.D?”
Are you really saying that with my Ph.D. (clinical psychology), I’m good enough to do a fellowship at the Mayo Clinic, spend 20 years on the faculty at Harvard Medical School, publish more articles in medical journals than the vast majority of physicians, and have both medical students and residents as students, but I’m not worthy of sharing doughnuts and conversation with physicians at a hospital where I might work?
That’s exactly what we are saying. Want to be a doctor? Go to Medical School.
You know what? We did have a good deal with paper charts, transciptionists and nurses who could really help us here. I gave my nurses limitations and they exploited them.
Example: Guy/gal is in between visits and needed their non-controlled antihypertensives refilled.
The took care of it and it was transparent to me. Now the doctor has to piss on everything!
Oh, and not get paid for it either!
The genie is out of the bottle and there is no going back. DPC is nice work if you can get it.
May anyone who distorts primary care to young people to get them to go into it, end up in Hades or at least purgatory for a few millenia for their deception.
“We did have a good deal with paper charts, transciptionists and nurses who could really help us here”
That’s exactly the way we run our office – it’s still possible if you don’t buy into the group think.
Unfortunately I misplaced the reference. One is to place physician burnout as a psychological illness requiring the physician to enroll as an impaired physician in Medical Society support services including counselling, medications, and supervision. Won’t that help
Physicians need to revolt; that is, realize their power and wield it responsibly. The system cannot operate without physicians. So stop being complicit is your own demise. Refuse to be guilted into working within a system that does not provide adequate care to patients and slowly drains you of your humanity. I switched to a cash practice 10 years ago and love it. No cow towing to administrators or insurers, knowing my patients intimately and delivering exceptional care to keep them well.
Ok, so walk away from the AAFP, AMA or whatever primary care organization you belong to because they t’aint gonna change their tune about this or the MOC thing. You can take your
money and spend it more on review courses for MOC!!
Stopped recertifying with ABFM 10 years ago and dropped hospital privileges. No MOC, just CME. No squawks from insurers, malpractice carrier, or anyone else. Check it out.
Here, here!!!! Preach, Dr Desmond!
Couldnt agree more.
Good analysis, Doug.
Thank you, sir.
“it frees up doctors to see more patients”
That’s the money quote. These ass-wipes don’t give a flying f*** about physician burnout – they just want to squeeze out that last drop of productivity.
To be fair to them, that’s what they were hired to do. Physicians are idiots if they think administrators will EVER be on their side. Accept that it’s the Hatfields and McCoys, and deal with it.
It is right and just that the crushing clerical burden demoralizing physicians is being recognized and addressed.
Slaying the dragon that drives this drudgery will be far more challenging. I have reluctantly concluded that a UK style system may be indicated.
WHAT? Do you think docs in the UK don’t have to fill out all sorts of crap on a computer screen?
The closest thing to the UK system in the US is the VA. Have you ever read a progress note on a VA patient? It is actually difficult to discern that a physician saw the patient.
I work at the VA. 55-60 hours a week . I’m burned out. An administrator came by 2 weeks ago. No thank you from him. He told me I only had 35 billable hours a week. The wait to see me is 3 months. His solution was for me to see more patients with nurse visits which means I still see them with spending longer hours doing the mountain of clerical work. I told my wife for the first time in my life that I don’t want to be a doctor anymore.
For the people in the medical system, academics and corporate and government alike:
You have destroyed all that which you held to be evil and achieved all that which you held to be good. Why, then, do you shrink in horror from the sight of the world around you? That world is not the product of your sins, it is the product and the image of your virtues. It is your moral ideal brought into reality in its full and final perfection.
We’ve seen thirty years of wiping out the evil in medicine, and achieving the good. This is what we got. Tips and tricks about how to decrease the amount of physician suicide. How not to hate your job to the point that it makes you sick. Sounds like a big win to me, let’s keep going.
-No work is creative if done by a (robot) who repeats in uncritical stupor a routine he has learned from others.
-Your work is yours to choose, and the choice is as wide as your mind, that nothing more is possible to you and nothing less is human.
-To cheat your way into a job bigger than your mind can handle is to become a fear-corroded ape on borrowed motions and borrowed time.
-To settle down into a job that requires less than your mind’s full capacity is to cut your motor and sentence yourself to another kind of motion, decay.
-Your work is the process of achieving your values, and to lose your ambition for values is to lose your ambition to live.
-Your body is a machine, but your mind is its driver, and you must drive as far as your mind will take you.
(lifted from various Ayn Rand passages.)
And that’s what happened as medicine was turned into a thoroughly dishonest job, if not profession: the background realization that this has largely become a fake, sick game.
Ironically I was also thinking of Ayn Rand this morning in regards to the medical system. While I do think her anti-socialistic position of everyone earning their place is important, I see parallels in her stories which are not well reflected in today’s medical system The insurance companies and PBMs etc have become the railroads and steel mills. But they are taking advantage of their workers, which are now us. Along the way we have let them do this. It was small at first but they pushed it little by little until we forsake our control to them. Now we cannot easily get our control back. Our government has been complicit in allowing them to have control, and even Medicare is affected. This is one of the issues I had with her theories. If there is no oversight then an industry can control everything.
If Rand were to comment upon today’s medical industry, “meaningful use” and “pay for performance” would be the main targets of her ire as they are fake benchmarks that do not actually reflect the performance of the goal of those in the industry and actually interfere with delivering the product.
It’s not a “Doctor’s Lounge” Doug, it’s the Provider’s Lounge. And we have resiliency training, deep breathing, energy crystals and kale for you right there in that safe space. Enjoy.