Doctors on COVID-19 wards deserve better

Doctors on COVID-19 wards deserve better. They deserve trigger-based outreach – especially when a patient who dies is also a colleague. They deserve ways to express their well-being needs safely, even anonymously. More than that, they deserve the system to drop the pretense that all doctors need is personal resilience. Doctors deserve to have organizational support strategies, alongside personal accountability of hospital managers to allocate resources for support, and to reduce the impossible burden.

Just like increasing patient satisfaction requires extensive effort, commitment, and resources over time, reducing physician burnout and increasing their satisfaction merit no less.

At a national health conference, a VP of performance improvement for a hospital network said that they’d recently run their first employee satisfaction survey and realized how burned out our physicians are. She told the audience that one physician said, “I’ve been working for this hospital for the past 20 years. No one has ever thanked me for doing a good job.” It’s literally the same as patients craving to be seen as human beings. And it’s their employers’ responsibility to make sure they are thus treated.

The hospital network now sends doctors’ spouses thank you letters on birthdays, realizing how crucial spousal support is to the doctors’ well-being. The network became keen on making doctors “rediscover joy in the practice of medicine” – which was of course associated with the expectation that they perform at a higher level.

After the panel, I was waiting to speak with the VP, when a doctor approached her and talked about his isolation and ways for breaking out of it. He included me in the conversation and recounted excitedly how he’d met another doctor from his hospital at their kids’ softball practice. They knew each other’s name from various forms they’d both signed when dealing with mutual patients. After years of working for the same employer, they’d finally met, outside of the hospital. Clearly, he had felt siloed. His hospital system was working on it, he said. He became quite emotional when telling us about the knitting group for doctors he’d joined. It provided a hobby as well as a refuge from illness and loneliness.

A review that explored the causes of burnout suggested that burnout could be reduced by improving clarity in work roles, organizational communication, feedback, openness, and developing a shared vision. Plus, “improving workplace social support through enhancing peer to peer or supervisory support.” Amen to those. The main cure to burnout was: “decreasing job demands by having more people do the same tasks, giving more time per person to do the same tasks or reducing the number of tasks per person.”

Hospitals are businesses, for the most part, profitable ones – operating at a profit margin of 8%. This means that they can afford to re-examine their task assignment and workforce policies. Plus, in one example, the University of Utah Healthcare system has managed to improve patient and employee satisfaction, quality, and safety of care, while reducing costs.

A sense of being connected to one another, acknowledged as human beings, can make a huge difference for both doctors and patients. A formal connection, when a patient is connected to a specific doctor, rather than to a clinic, is already beneficial. A study of over 150,000 patients showed than when a doctor could say you were “their” patient, you were more likely to receive guideline-consistent care, such as routine mammograms, and having balanced blood sugar levels.

Mary Catherine Beach, professor of medicine at the Johns Hopkins University School of Medicine, interviewed primary care physicians and discovered that while they liked “their” patients in general, they had a few favorites—mainly people whom the doctors took care of (and cared for) over a long period of time. One of the doctors said about such a patient: “He treasures me, just like I treasure him. “This kind of relationship is an emotional win-win for doctor and patient; a triple-win when you consider that the patient’s health may hang in the balance. No! A quadruple win, because doctors who experience less burnout, can also work more, and better withstand the health system burden. We cannot formalize a rule that will make people treasure one another. But we can ensure that they are not anonymous to one another, that they have enough time together, and are treated cordially. That’s a good start.

Patients and doctors depend on the health systems to allocate more time to appointments, to create visions and develop communication practices, and to bring in more professionals to shoulder the workload. Knitting classes are nice. But there isn’t enough yarn in the world to knit a blanket that decreases the job demands of nurses and doctors, which is what they need. When they break down, or a little before that, the health team need their employers to develop effective interventions, advertise them and make them readily available.

There are two people here. One is vulnerable in the patient role. Uncertain of what the doctor would find, and maybe in pain. Another is vulnerable in the doctor role. Frightfully overworked and too often socially isolated. Afraid of making medical errors, and afraid of being sued for them. What strange symmetry – one of us can sue the other, one of us has the power to cut the other up. Both of us want to be acknowledged as people. And the system under whose auspice we meet rarely gives us enough time to do so leisurely, or even to speak for 108 seconds uninterrupted. This does not bode well for doctor-patient relationships, for doctors’ burnout rates, or for our health. Thankfully, we can take action to make this better.

Talya Miron-Shatz is a health care economist and author of Your Life Depends on It: What You Can Do to Make Better Choices About Your Health.

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