“The patient-clinician relationship is dead.” Those of us in health care hear this refrain constantly these days, coming at us from all angles. We feel it in the wall that goes up when we turn from our patients to our computer screens. We infer it in administrative meetings in which we are told once again to get our numbers up, or when yet another physician is let go, technically “without cause,” but we all know he was the one trying to buck the system by setting limits. It is palpable when our patients seek help from urgent care centers during our office hours. And we feel it in our own hearts when we have an internal meltdown over five add-ons at the end of clinic or yet another admission before changeover.
How have we gotten to this point, where those of us who went into medicine for noble reasons have become detached from those we vowed to serve? You know we are in trouble when seeing patients becomes tear-worthy, when a clinician cannot stomach another day at the office or another shift.
At some point, physicians lost control. As government mandates came ever increasingly on board, we sold out to big corporations and accidentally industrialized ourselves in hopes that someone would take on the background noise. We needed someone to take care of the business end so we could keep doing our souls’ calling: serving patients. We thought we were getting a partnership, but while we were busy doing our jobs, we became ensnared. Now, we ping-pong between four conflicting masters: our employers, insurance companies, our patients, and our personal responsibilities.
The overarching cadence goes something like this: “Do more. Do more. Do more … but do it with less.” Less staff, less time, less resources. And make sure you keep those patient satisfaction scores up and keep up with the latest in RVUs/meaningful use/ICD-10 codes. Where exactly does patient care fall in any of that? Is it any wonder that burnout statistics in health care are staggering? Should we be surprised that providers are dying of suicide at the rate of one per day in the United States or that health care providers are laying down their stethoscopes and literally fleeing for their lives?
Since publishing an article about healing from burnout, I have heard from many frontliners in health care about their own painful experiences. Their stories are startlingly similar: a young person with a unique brand of intelligence, perseverance, and compassion feels a calling, dedicates her youth to this calling, and then has her humanity forced out of her by a broken health care system until she is left cynical, exhausted, and finally, numb. I have become so attuned to burnout that I can spot victims from across the room. They look lost and near tears and haunted. They look like soldiers returning from war.
And yet …
I offer you a glimmer of hope. Like a tiny seedling, something new is emerging. Providers, tired of losing their friends and colleagues to the exit door or the grave, are uniting and speaking out and health care systems are beginning to taking note.
We are fighting for you, dear patients, by leaving abusive employers and joining on with more progressive and supportive organizations or by leaving industrialized medicine behind completely. Health care workers are sharing their own stories of burnout and recovery in order to pave the way for others who are still struggling. We are annihilating tired stigmas by openly seeking therapy ourselves, thereby creating a chain that others can grab onto. Training programs are adding wellness initiatives into their curriculum. And patients are fighting for their providers, too, speaking out as they are hurtled along the conveyor belt through Big Medicine’s machinery wheels, insisting that they get a say in their own medical team and inconveniencing themselves to see their own doctor instead of popping into the nearest med check.
And then, there’s this: I published an article recently about a patient whom I loved and ultimately lost during residency training. I wrote it for myself, as a means of coping with that loss, and I wrote it for you, so you would see that the patient-clinician relationship does matter. It matters and it will always, always matter. Because if you remove the computer screens, government mandates, patient satisfaction surveys, inflated census requirements, and third-party payer systems, what are you left with? You are left with people. People on one side who are seeking help and people on the other side who want to help. It’s that simple, and it’s that profound.
My little article was shared from the publisher’s website over one hundred thousand times in the first week. Each time that number rose, it felt as if someone was grabbing me by the shoulders and imploring me to take in the lesson here: what we do matters. We matter. People didn’t share that article because it was particularly well-written. They shared that article because humans are hungry for connection, for understanding, for love in the face of fear and hardship. Medicine is sacred, and people on both sides of the line want it to remain that way.
Providers: Do not give up. You are touching lives. You are changing lives. You are weary, but you are not broken. You do not need more resiliency training; you, who survived medical school and residency and beyond, are amongst the most resilient humans on the planet. What you need to do if you are suffering is dig your way out; stand up, and get out and find a better way. As someone who did that, I promise you, there is a way to love the practice of medicine again. Do not believe employers who tell you it’s no better anywhere else. That is a lie, designed to keep you plugging away.
Patients: Do not give up. We see you, we hear you, and we are fighting for you. You deserve better, and we will get you there.
Hospital administrators: Do not give up. Your organizations are providing access to state-of-the-art care for millions of patients across the country every day. Many of you are hurrying to develop literal life-lines for your providers and staff. Those that aren’t yet are likely just behind the times; let us work with you to find a new way.
Too many of us have shut down all feeling so we can move faster and turn our eyes away from the suffering we don’t have time to process and the painful knowledge that we aren’t practicing medicine the way it was intended. We must not allow ourselves to go numb. We need our patients just as much as they need us.
Set your standards high for maintaining these relationships, which means setting reasonable patient-load limits. Advocate for compensation models that value the practice of good medicine over high patient numbers and for better EMR systems that work for us instead of against us. Fight for the autonomy that allows you, as a professional, to determine what amounts to a safe and manageable patient load and how much time you need per patient. Do not allow yourselves to be harassed or abused on the job for the sake of serving others: You are not a martyr, and you are not a machine. Crying is not weak, feeling emotions is not a hindrance. Feel and feel some more. Reach out. Hang on.
So, let me ask you: Is the patient-clinician relationship really dead? I’m not nearly finished with the fight to prove that it isn’t. The care we provide for our patients and their families will heal the healers … and that’s the only way forward.
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