As physicians and health care teams around the world find themselves facing the unprecedented challenge of COVID-19, the topic of how we care for ourselves and our professional colleagues has never been more important. I’m part of a care team – physicians, nurses and allied health care professionals – that knows all too well we have the potential of 'crashing' at some point. Today, 42% of physicians experience burnout. The additional stress of providing care during a pandemic, which is changing by the hour, while also managing our everyday personal and professional stressors, will only contribute to this issue.
If you’re a rock music fan, you may know the song "Comfortably Numb" from the classic Pink Floyd album, "The Wall." It’s a good tune, and sometimes it pops into my head at work. As a physician, I’m more likely to use the phrase 'uncomfortably numb' to describe our health care milieu.
We like to be more strategic than tactical; unfortunately, our days are often consumed by survival mode activity – devoting a significant amount of time to issues that come 'crashing into our windshield' at any given moment. Because of this, physicians are not always able to remain engaged in our day-to-day work as much as we might like. Physicians are particularly susceptible to being caught within the extremes of life satisfaction and stressors – it’s this shifting spectrum that can easily lead to burnout. In one instance, we experience the euphoric feeling of saving a life. Moments later, we’re crushed and utterly devastated by the loss of a patient. There are several variables leading to physician burnout, making it a challenge to adequately address in a holistic fashion.
The root causes of physician burnout
Physicians may experience burnout in different ways. I think of burnout causes in four main categories:
For physicians, autonomy is best in moderation – too much or too little can be a bad thing. Today, some physicians are experiencing a loss of autonomy. For example, as hospitals are acquired by larger health care systems, physicians may have to adapt to more stringent policies and requirements. These measures are put in place to regulate the way we practice medicine and protect the patient, but for many experienced physicians who are accustomed to established norms, these new constraints can have adverse effects.
Whether we’re interacting with patients, nurses or other physicians, consistent and effective communication ties our entire industry together. In return, poor communication is detrimental to health care goals, and mistakes happen most frequently when communication fails. Every hospital, group practice and solo practitioner should have communication as the top priority.
Failure to engage physicians can happen on several different levels: between members of the care team, across the hospital system or out among the community as spokespersons for the hospital.
Organizations that don’t effectively engage their physicians will find their most valuable advocates lacking loyalty to their mission. Physician buy-in to organizational values is critical to the success of a system.
Physician expectations are increasing at an exponential rate. From taking care of patients to understanding and executing reimbursement models to safeguarding patient and family satisfaction, we often have our hands full.
Organizational response to physician burnout
There are several steps a health care organization can take to be proactive about physician wellness. Health care systems have a responsibility to provide their physicians with a network of support and the option for at-work resources. Community programs, such as group therapy, meditation, well-being classes and yoga, plus good nutrition and exercise can help combat burnout.
We need to think about physician burnout on the spectrum of depression, because it shares similarities and symptoms. Something as simple as a physician lounge permits private communication in addition to relaxation, and it’s critical to provide physicians a personal space to decompress. Another critical step a health care organization can take is to invest in an IT infrastructure that optimizes the physician workflow.
The need for flexible EHR training for physicians
Technology is meant to be an answer for stressors contributing to physician burnout. When an electronic health record (EHR) hasn’t been properly implemented or physicians haven’t been properly trained, this can be another stressor, especially at the beginning of the implementation. I like to compare EHRs to more complicated and intimidating medical tools. Consider robotic surgery systems, which are some of the most exciting technologies medical professionals use today. To operate a robotic arm and perform surgery with this tool requires hundreds of hours of supervised experience. Specialized surgeons must undergo tedious training courses and mock surgeries before they're certified. We wouldn’t expect to put a surgeon into a room with this tool and ask them to perform surgery without sufficient training, so why should the EHR be any different? It’s critical to give physicians adequate training and a realistic timeline to immerse themselves into their EHRs. By providing the proper resources, we can empower them to use this technology in the most effective manner possible.
Health care IT leading the way to physician wellness
Elements of health care IT are changing the way physicians work. For example, voice recognition technology is a complete game changer for documentation. Prior to this technology, physicians spent a significant amount of time transcribing notes, correcting records and waiting for transcriptionists to deliver valuable documents. Today, we can record our thoughts once and be done, eliminating the tedious aspects of note taking.
Preparing for visits, especially when seeing a patient for the first time, has been simplified through the introduction of the EHR. Before an electronic format, physicians were handed patient records in folders, sometimes filled with hundreds of documents from a range of physicians, clinicians and specialists. Now, the patient record arrives through one easily accessible electronic portal. EHRs bring the most pertinent information to the front of the dashboard in an easily digestible format that makes us better – and happier – at our jobs.
Technology has also elevated the patient-physician relationship. Previously, there were few options to communicate with patients other than in-person or over the phone. Today, we have electronic patient portals, apps and telehealth communications that help us engage patients within their own health care journey more than ever before. From lab results and X-rays to before and after scans of shrinking tumors, we can help the patient take ownership of their health, which improves our relationship. This has made the medical profession more satisfying for physicians and combats some of the deepest roots of burnout.
The coming weeks and months will be extremely challenging for physicians and other clinicians in various health care settings around the globe. As we strive to meet the heavy demands of providing quality care during a pandemic, health care IT tools, coupled with a support network, can facilitate our continuing path to wellness. Through a combination of onsite resources and improved IT infrastructure – we can effectively promote care team wellness by improving communication, increasing engagement and managing expectations for our physicians.
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