As we’ve seen, the lives of those working in the health care system has become overwhelmingly challenging, burdened by all of the excess nonmedical stuff that has been added into our lives as we try to take care of patients.
From prior authorizations, to clicking in the electronic medical record, to endless streams of regulatory requirements, to the continuous onslaught created by email and texts and patient portal messages, providers are left feeling like they’re not getting to do the things that they want to do, the reasons they went into medicine in the first place.
We chose this life because we love taking care of patients. We went to medical school and learned to be a doctor so that we could do doctoring. We went to nursing school and learned to be a nurse so that we could do nursing. And for all the other roles of all of the other members of the health care team, we are trying to do that job, and we are not being allowed to do it.
True, in every type of employment, there are things that go along with it, things that really aren’t the focus of your job, aren’t the meat of what you love to do, that just have to be done, but it feels like we are practicing in a toxic health care environment that is taking us too far away from the practice of medicine.
Taking away our evenings
A few years ago, I went to a lecture by a senior academic physician about his life in medicine, and how he’d done all these different things, including writing several books about medicine.
Several people in the audience asked him, how did you have time to do this, when we work so hard in the hospital all day long?
He responded that no matter what, when he left the hospital, he went home and had dinner with his family, and then spent several hours writing.
But today, we hear that everyone is going home after a hard day’s work, and spending several hours with their electronic medical record, typing, and clicking, finishing up what didn’t get done, what couldn’t possibly get done, while they were taking care of patients. If we want to inspire the next generation of doctors, nurses, nurse practitioners, and the rest of our team to want to enter the field of primary care, or for that matter almost any aspect of medicine, then we need to demand the system that frees us up to do what we have all been so intensely trained to actually do.
Can you imagine a surgeon being told that she needs to spend hours and hours clicking in the electronic medical record, rather than operating as she was trained to do? Sure, they have to write notes in the office visits before and after surgery, and there’s that operative note that says that the patient was prepped in the usual sterile manner, and that all sponge and instrument counts were accurate times two at the end of the procedure and the patient was transferred to the recovery room in stable condition. But it often feels like those practicing outside of primary care get to focus on one little thing, whereas we get overwhelmed with everything.
I’m not complaining — we love doing everything, but systems need to be set up so that we have the support to allow us to take care of our patients, to allow us to do the actual doctoring or nursing, to let everyone practice up to their license. Why does the primary care doctor have to fill out the home care form when the patient goes home after their surgery? Why does the primary care doctor have to fill out the durable medical equipment supplies request that takes care of the condition that the subspecialist is treating?
At its best, this job is hard. For years we’ve known that the psychological strain of taking care of patients, of worrying about them — did we do the right thing, did we miss some terrible disease, did we do harm — leads to a high level of stress and provider burnout.
Adding all of the rest of the bureaucratic and systemic noise into the lives of providers has clearly led to a greater degree of burnout, providers leaving their practices, retiring early, changing careers, feeling dissatisfied with their work.
There have been numerous financial analyses that have demonstrated how much it costs to hire, train, maintain, and replace a physician. It is always within an institution or a practice’s interest to keep the providers that they already have working there, rather than lose them and have to find someone new to take their place. And if they’re trying to find people to take their place in a job that is less desirable than in some other place, this only makes matters worse.
If the institution or practices where we work value us, feel that we serve a purpose, respects the fact that we are doing this hard work taking care of our patients — taking care of their patients — then you’d think it would be worth them investing in almost anything we need to make our lives better, to keep us from moving away, from burning out and moving on.
I’m not talking about lip service gestures, a raffle to win a massage, a free backpack, meditation sessions, praise cards, and emails, these are just not going do it. If I leave work for an hour a day to get a massage, then I’m an hour farther behind when I get back.
A primary care foundation
We need the powers-that-be to be actively engaged in building a solid foundation of primary care, because that’s the lifeblood of any health care system.
Those of us doing preventative medicine, managing acute and chronic conditions, referring people to specialists, and so on for more procedures and operations, are essential to a healthy health care environment. So I think that we need to find a way to have everybody who makes these financial decisions acknowledge this, let them do the math, let them invest in true provider burnout prevention, because it’s worth it.
Think about it. If we removed prior authorizations, the arguing with an insurance company about a CT scan we ordered, or trying to get patients authorized for a medication they desperately need — if we could get all of that to go away from the physicians, then we could focus on taking care of our patients, give better care, and provider satisfaction would improve, and patient satisfaction would surely follow. And we would stay, and keep doing what we love doing, keep caring for our patients.
There are countless examples of the “work” we’re doing that just doesn’t need to be done by us, and it must be economically feasible to build a system where someone else can do this and let us focus on the patient in front of us.
Because we are worth it.
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