The emergency room is packed. I interject another question to further clarify when exactly Mrs. Smith’s chest pain started, cutting off a story about her daughter — a tactic I would have found unthinkably rude only years before but has now become a necessary technique. After leaving the room, I try to put in orders, but the electronic medical record resets itself, I’m informed an X-ray won’t upload unless I retype the request in a specific and lengthy way, the phone rings, an EKG is dropped in front of me to be interpreted, and a patient calls over the desk for my attention.
A knot of frustration rises in my gut, and I close my eyes for a moment. I can imagine thousands of strands emanating from my little corner out into the vast night — endless need, endless requests, endless metrics, endless obstacles — each combining with the others to create a waterfall that engulfs me.
Recently, 10 prominent health care CEOs declared the trends of physician burnout a “public health crisis.” Over the past several years, burnout has increased over 10 percent in more than 10 specialties and is above 50 percent in most specialties. The drivers are complex and broad, from increasing regulatory burdens and ever-rising productivity demands to labyrinthine organizations and ineffective electronic medical record platforms.
As these CEOs report, physician burnout is more than a nuisance; it has real impact on a physician’s health, patient outcomes, and a hospital’s bottom line. Every percent of increase in physician burnout (as measured by a validated instrument) correlates to a 48 percent likelihood of decreased clinical activity in the next 24 months, according to the report. If physicians burn out to the point of leaving, the cost to the hospital ranges from an estimated $500,000 to $1 million for recruitment, training, and lost productivity.
To address physician fatigue from an organizational level, it needs to be measured. The use of validated instruments administered tactfully through low-friction, well-designed systems can provide valuable information without creating more paperwork for already overburdened physicians. As many specialties incorporate shift-based coverage, such as a hospitalist role, understanding the threshold of workload and effects of scheduling patterns on fatigue is valuable. Well chosen software, such as intelligent scheduling platforms or low-friction survey tools, may provide a window of insight into how physicians adapt to certain workloads and allow leaders to act accordingly, improving the physicians’ experience and reducing costly turnover.
It’s encouraging that leadership in healthcare recognizes the need for organizational change, and I hope it comes quickly through well-chosen strategies. But what can we, as individual providers, do tomorrow?
Personally, I make a concerted effort to be inefficient.
In the day-to-day, what permeates the clinical experience is a relentless drive for speed and volume — seeing more patients even faster. The distracted and rushed physician has become a common archetype in the public imagination. Just as the patients walk away from compressed and brief interactions discouraged, so does the doctor! We go home exhausted, wondering what happened, having expended so much energy but feeling so little connection to the patients we were trying to help.
Efficiency is important but often consciously or unconsciously held as an ultimate value, only checked by the need for safety and little else. What is threatened to be lost, however, are the human moments that make patients feel cared for and leave physicians more satisfied with a career that was once their calling. If not metered, the pursuit of efficiency threatens to strip medical practice into its most skeletal and mechanical iteration — the physician reduced to a frantic technician and the patient an object. The space needed for beauty, grief, reassurance, and unexpected connection is dangerously void of anything practical or measurable. How easy it is to let such an ephemeral idea slip away in the churn of metrics, regulations, and policies that now push doctors through their days.
I give myself permission to find a moment to slow down and connect. I don’t do it to improve the patient’s experience or buff my care satisfaction scores; I do it to improve my own experience, to reclaim a sense of meaning that is in the balance of being lost, and to sustain myself so that I can come back tomorrow and do it again. If it throws off an occasional metric, so be it. At some point, we have to make a claim for what is truly valuable in our practice, both for the patients and ourselves.
Later in my shift, I walk back into Mrs. Smith’s room and close the door a bit, muting the noise outside, and ask about her daughter. She resumes her story, smiling, and moves her leg over as I sit on the edge of the bed. Then, over an unexpected moment, we both laugh. A few minutes later, I walk back out into the cacophony of the ever-humming emergency room, still chuckling to myself. Do you know what? It feels pretty damn good.
Matthew Wetschler is an emergency physician. He is a member, physician advisory board, Lightning Bolt Solutions.
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