Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. is nothing more than putting proverbial lipstick on a pig. Or, stated differently, this may amount to a very muted and unintentional form of victim blaming: “If doctors just learned to take better care of themselves, they wouldn’t feel burnt out!”
Physicians in the U.S. are not well. Our chances of suicide are significantly higher than the average person’s. More than half of thousands of U.S. physicians surveyed in a Mayo Clinic Proceedings study reported professional burnout. Burnout is a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization) and a low sense of personal accomplishment. So, it might seem natural to try to help physicians out in some way. But the focus on training physicians to be more “well” in an increasingly difficult and toxic health care system is akin to telling a domestic violence victim to take better care of him- or herself to better tolerate the abuse. That would never happen!
The current health care system abuses physicians. With increasing technology have come electronic health records (EHRs). However, these often-burdensome systems are not built for physician efficiency and rather have turned into medico-legal wonder-tools full of checkboxes and liability-focused jargon. If it is not written in the record, it did not happen. That makes EHR charting an exercise in verbosity and excess that is helpful to lawyers but not to physicians or their patients. A study published in Annals of Internal Medicine and further publicized by Forbes showed that for every hour physicians spend providing direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work. Add to that: increasing regulations and requirements for documentation and reporting for major health insurance programs; a culture of litigation that encourages frivolous lawsuits; excessive time spent arguing with staff members — many of whom are not even medically trained – at insurance companies about why patients need the medications that they are prescribed (the dreaded “prior authorization”); and hospital systems that measure physicians in terms of production, encouraging unreasonably packed schedules that do a disservice to both physicians and patients.
What you are left with is an epidemic of burnout.
To cure what ails our nation’s physicians, we should not focus on physician wellness programs. That is not to say that these programs are bad — they do good, but they are simply a very small bandage on a large, gaping flesh wound. What we do need is widespread reform of our health care system from multiple angles. Tort reform, a focus on creating effective and efficient EHRs and protecting physicians from overloaded patient schedules would be fine places to start. Haagen-Dazs is nice, but I think most of us would trade the cup of rocky road for a more humane quality of work-life.
Linda Drozdowicz is a psychiatry chief resident.
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