The practice of medicine has experienced its own version of climate change

When you or a loved one is sick or injured, health care decisions are fundamentally a matter of trust.  You trust your physician will have the answers you need, because you know that, as a highly-trained medical professional, they’re qualified to make the best recommendation for each and every patient under their care.

Physicians receive some of the most rigorous education and training of any profession. They spend the better part of a decade preparing to practice in whatever specialty and setting they choose.   Physicians are the “perfectionists,” “workaholics,” and the “superheroes” of health care. They strive to do it all, and patients expect them to.  Physicians put in the extra hours, take on complex cases, and complete the administrative tasks that are now just another part of their job description.

As the current generation of medical students transitions into residency, and eventually into medical practice, they will face a very different reality than I did when I entered the “real world.”  When you’re in medical school, you are trained to be the team leader and to be confident in every informed decision that you make, because if you’re not, the team simply falls apart. That leadership mentality is bred into medical students and reinforced in residency.

Sadly, however, the practice of medicine has experienced its own version of climate change.  The rising tide of increased patient census, the exponential explosion of medical information, the loss of physician autonomy, and the growing prevalence and complexity of IT is starting to undermine the physician’s primary focus: clinical care.  This continuous erosion of central purpose saps confidence (“What did I miss?”), dilutes focus (“I am here for my patients”) and is already washing away passion as evidenced by more physicians leaving medicine.

As a practicing hospitalist for 20 years, I’ve witnessed this tectonic shift first-hand. When I first started my career, I saw 12 patients per day.  With that caseload, you had time to interact with patients and colleagues. You could bounce ideas off one another, learn from each other, and take that extra moment to fully digest a complex case before moving on to the next. Time spent on documentation wasn’t as extensive. The clinical note was a concise, personally curated document, the sole purpose of which was to advance the care of the patient. Now, panels are larger and that note has expanded to encompass a deluge of patient data that mostly regurgitates contextually irrelevant information already contained in the EHR, while masking the clinically significant nuggets.

EHRs were put into place with good intentions and for good reason, but we neglected to take the physician environment into account. Unlike virtually every other industry, health care has added technology and reduced the productivity of its most valuable human resources.

Technology should not be a burden to physicians. It should instead be an asset, facilitating an increased percentage of time at the bedside while helping physicians to be more efficient and a little sharper.  For example, as a hospitalist, the first thing you do in the morning is pre-round, which can easily take up to an hour.  Imagine a platform that would communicate and function as a trusted colleague as opposed to an obstructive force; that would streamline the process by highlighting critical changes overnight; that would assist with task prioritization/completion and analyze data for diagnostic clues intelligently and in a manner that is consistent with how that physician practices.  It would get physicians on the floor sooner, and to the patient’s bedside earlier. That is but one potential for health care technology.

I used to teach in medical school, and I’ve seen students come into class eager to make a difference. They knew what they’d signed up for when they began studying medicine and were willing to put in the work to make a difference in the lives of their future patients. It’s disheartening to think of those bright, hopeful minds stuck behind a computer screen, entering endless rounds of notes, when instead they could be at patients’ bedsides guiding their care, and gaining their trust.

Going forward, what must be retained (or rebuilt) in health care is a fundamental respect for the physician’s role and expertise in treating patients. That begins with acknowledging, and ultimately improving, physicians’ work experience.  As a physician, if I wasn’t devoting the second half of my day to the EHR, I would have more time to spend with patients. It’s that personal aspect of care that technology can’t replace, and which the vast majority of physicians want to deliver.  Restoring balance in a physician’s ecosystem between the clinical and non-clinical elements will reconnect physicians with their love of medicine.  One step is to make targeted IT changes that have a huge impact, starting with the EHR.  Health care is potentially far better off for having an electronic foundation.  Now we must discover a way to make the computer so intuitive, almost instinctive, for physicians that it is actually an asset, making us better. My goal is that we reach that potential before the climate for physicians in medical practice is irreparably harmed and it’s too late to fix it.

 Christopher Maiona is chief medical officer, PatientKeeper.

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