Burnout Roundup October 1 2019

Here’s my curated list of top 5 articles on burnout for this week, with a theme: the EHR (electronic health record).

by Joe Harpaz

One example: many (if not most) EHR (electronic health record) systems were designed for primary care. But a specialist using an EHR designed “for a primary care physician would be akin to a server at a restaurant attempting to place a food order on a system meant for retail applications. Screens and questions might be out of order and fields for documenting patient responses may be missing or require shorthand when a symptom or billing code isn’t available from a pre-created list. When we attempt to create a “one-size-fits-all” solution and shoe-horn it into all aspects of healthcare, the result is an EHR system that puts “paperwork” first and foremost, not the needs of the physician and patient.”

This is a big contributor in physicians spending 2 hours at the computer for every 1 hour spent with a patient. Hours that are not allotted to most physicians during their working hours. Thus done on their own time, usually after hours and on weekends.

by Cindy Foster, Senior Public Affairs Specialist, UNM Health Sciences Center

“‘We are losing the equivalent of seven graduating classes of physicians yearly to burnout and, as they leave the profession, they point their finger at the time now required for them to document their work and how it has led to the loss of quality time spent with patients and families,’ says Philip Kroth, MD, director of Biomedical Informatics Research, Training and Scholarship at UNM’s Health Sciences Library and Informatics Center and professor in the School of Medicine.”

“Clinical process design and the clinical culture — both of which are highly impacted by the electronic health record — contribute to approximately 40% of total clinician stress. ‘Our electronic medical chart notes have grown until they are 10 times longer than physician notes in the European Union,’ he says.”

“While physicians are leaving the profession in record numbers, no one has been able to show where the vast amount of information being accrued into medical records is benefitting patients, he says…’but to date there has been no research showing an overall reduction in mortality, improvement in quality of life or reduced hospital admissions.’”

“‘We went to school to see patients, but now, for every minute we have with a patient, we are spending two additional minutes on the computer,” Kroth says. “It often takes a 60-hour week just to keep up with documentation, and that is tough on personal relationships and families.’”

by Michael Blanding

For those hospital systems that might care more about the finances than physician well-being, this is a strong argument to take action.

“‘Physicians don’t sign up for the job to stare at a screen. They are doing this to provide care for people,’ says one of the study’s co-authors, Joel Goh, a visiting scholar in the Technology & Operations Management Unit at Harvard Business School. ‘It creates a high level of dissonance for them.’”

“… the study shows that doing the right thing ethically can also make sense to the bottom line. ‘It’s not just going to be a waste of resources trying to deal with this problem,’ Goh says. ‘Aside from all of the positive outcomes you generate, it’s probably a good financial return on investment as well.’”

“‘One way to make a difference is by increasing the amount of administrative support doctors receive, so they are relieved of those burdens,’ Goh says. “‘It may seem costly to hire that additional staff, but it will probably be beneficial in the long run.’”

by Marty Makary, Johns Hopkins professor and author of the new book “The Price We Pay: What Broke American Health Care and How to Fix It” (Bloomsbury Press)

In this New York Post article, Dr. Makary outlines the following 5 steps:

  1. Price Transparency
  2. Patient-centered solutions
  3. Get rid of the middlemen
  4. Ban kickbacks
  5. Eliminate inappropriate care

My favorite quote:

Doctor Coding, billing and clicking through electronic health records instead of spending time with patients is why physician burnout has reached record levels.

marty makary

I haven’t had the opportunity to read Dr. Makary’s newest book yet (but to be sure it’s on my to-read-next list!). But his prior book Unaccountable is one of my all-time favorite books-on-healthcare, and one that I recommend every physician read.

by Rachel Popa

  1. “Physicians need to have some control and autonomy in addressing these issues and improving their work lives. It’s easy to suggest solutions for burnout, but clinicians need to have a say in what they want and need, rather than having solutions applied to them.
  2. “EHRs can drive significant improvements in patient care, documentation and efficiencies, but they can also add to the burden on physicians and their teams, especially if they are not effectively trained after their initial go-live or during new hire on-boarding. As new processes or technology optimizations are developed, doctors also need to be involved so everyone is on the same page about how the technology should function.”
  3. …providing resources and changing the dialogue around mental health — all things that will reduce and possibly eliminate burnout in the future.”

What did I miss? Do you know of an article that should be on this list? Comment below or contact me!

see prior roundup — September 15, 2019

see all prior weekly Roundup articles and other physican burnout resources on my physician resource page

Originally published at The Hopeful Cancer Doc.

Physician/writer. Essayist, published in NEJM, JAMA, JAMA Oncology, Journal of Clinical Oncology, and The ASCO Post. Doximity Op-Med Fellow.