Working Too Hard Doesn’t Cause Burnout. Having to Do the Wrong Thing Does

Physicians are generally highly motivated to treat their patients well, both in terms of clinically well and in a nice manner. When they don’t do that, it isn’t usually because of personality disorders or character flaws, but because their jobs are robbing them of their enthusiasm and compassion.

Sometimes it is our own fault that we get burned out. I realized this ten years ago today (!) when I read Claire Burge’s post about burnout skills. We are, by nature and by training, fixers and problem solvers. Because healthcare these days is so dysfunctional, many of us feel like we should be heroes and do “the impossible” in spite of limited time, resources, support and so on. When we do that, we get external praise or praise ourselves, so we end up doing it again. That can be a vicious cycle of always fighting uphills battles, ultimately at our own expense.

But many times, we risk getting burned out even when we aren’t over-capitalizing our heroism. Sometimes the everyday, totally routine tasks put us at risk for burnout. A lot has been written about moral injury in healthcare as a cause for burnout. I agree that can be a dramatic contributing factor sometimes, but I firmly believe the most fundamental cause of burnout is that we, trained clinicians, diagnosticians and decision makers, are put in the position of public health nurses and data entry operators.

This is a terrible waste of a medical education and a sure way to job dissatisfaction and burnout.

It is frustrating for physicians to hear that everyone in their organization except them should work “at the top of their license”.

Think about it:

A patient is due for their ten year colonoscopy recall. The surgical clinic sends an electronic message asking the primary care physician to make a referral so the insurance will pay. It isn’t enough to respond or forward a “MAKE IT SO” command. No, the physician has to create a non-billable encounter, locate the correct diagnosis code for screening for malignant neoplasms of colon, Z12.11, click however many times it then takes to indicate the provider or clinic and send the order off to the referral coordinator.

Or:

A patient comes in for a sore thumb and is behind on all kinds of screenings and chronic care. Instead of devoting the visit to making the correct diagnosis, bacterial paronychia versus herpetic whitlow, and then treating it correctly, the physician is now held personally responsible for catching the patient up on things that could have been figured out and handled by an unlicensed staffer under the supervision of a public health type nurse working with practice wide protocols.

If there were “efficiency experts” analyzing what we do in healthcare, would they really recommend that the people with the highest degree of education do the most basic functions of data entry and checking off health screening protocols?

I find the priorities of modern primary care bewildering. I personally feel less burned out when I double book sick patients or stay late to take care of a complex new patient than when I am put in a position of bookkeeper. If I wanted to be an accountant or a public health nurse, I would have gone to school for that.

The Counterintuitive Concept of Burnout Skills

6 Responses to “Working Too Hard Doesn’t Cause Burnout. Having to Do the Wrong Thing Does”


  1. 1 Regina South June 4, 2021 at 6:29 am

    YES!

  2. 2 Spring Texan June 4, 2021 at 9:45 am

    As a patient, I have a comment on “A patient comes in for a sore thumb and is behind on all kinds of screenings and chronic care. Instead of devoting the visit to making the correct diagnosis, bacterial paronychia versus herpetic whitlow, and then treating it correctly, the physician is now held personally responsible for catching the patient up on things that could have been figured out and handled by an unlicensed staffer under the supervision of a public health type nurse working with practice wide protocols.”

    I agree that the doctor should NOT be doing this, but frankly as a patient I don’t want a staffer doing this either at the time I come in for a sore thumb. If a doctor’s office is going to nag me about everything (many items of which I have very consciously decided NOT to do and with though) every time I come in, that only makes me avoid the doctor even when I DO have a problem. We should stop equating PCP care with being a health nag and have a more reactive rather than pro-active system.

    Some people do feel cared for by insistence on a bunch of stuff, and some people likely need informing, but there needs to be a way to opt out of that (fortunately my PCP lets me dismiss something and then she never brings it up again for years – but she got a nurse practitioner and I almost had to quit the practice till she said I could resume seeing her again). I want the doctor to address the problem I come in with.

  3. 6 WKL June 10, 2021 at 10:58 pm

    This is everything wrong with our patient care’


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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