A Country Doctor Reads: The Solution Shop and the Production Line — The Case for a Frameshift for Physician Practices | NEJM

The other day, as we were both struggling to pull off a visit every 30 minutes with a brand new EMR following a very cursory onboarding, Autumn told me a new nurse coordinator had called and said Mr. White was due for his annual urine microalbumen test.

He had just left the office. I shrugged and said “I had all I could do just to import his medications, vitals and even the assessment and plan into his blank office note. If whoever she is knew he was due, she could have entered the order if we had a standing order. I’m a problem solver, not a bookkeeper”.

Later that day, waiting for my dinner to cook, I picked up last week’s The New England Journal of Medicine and noticed an article by Christine Sinsky and Jeffrey Panzer about exactly this kind of issue.

In The Solution Shop and the Production Line, they make the case that doctors shouldn’t be the ones held responsible for things that can and should be automated. Our time and effort should be more directed toward relationship building, diagnostics and treatment planning.

I think the bookkeeper analogy is perfect. I believe it is a consequence of non-clinicians trying to understand what we do and failing to grasp the complexities of medicine. Our training and our temperaments are focused on diagnosis and treatment. With all the computer power involved in healthcare these days, why does anybody think it is appropriate and cost effective for the physician to enter annual orders from memory or at the command of nurses who could easily do that with standing orders in place.

No wonder we have a perceived doctor shortage in primary care in this country: We are too often asked to do bookkeeping tasks at the expense of intellectual, clinical, educational and motivational efforts for the benefit of our patients.

Dr. Sinsky knows this. Her job at the American Medical Association is to fight physician burnout.

It can’t be said enough: The root cause of physician burnout is that we are required to do and evaluated for excessive amounts of non-physician work in today’s healthcare environment.


2 Responses to “A Country Doctor Reads: The Solution Shop and the Production Line — The Case for a Frameshift for Physician Practices | NEJM”

  1. 1 Robert Stuart August 1, 2022 at 4:10 pm

    What Dr, Sinsky is unwilling to consider is that the EHR is profoundly inimical, even destructive of solution shop-type work.

    I guess that would just ruffle too many feathers.

  2. 2 Tobin Jacks MD August 16, 2022 at 1:09 pm

    All “deep state” stuff. Admin and the government are literally killing primary care. There is so much money changing hands right now, none of actually going to patient care. How can you be such a supporter of the Democrats? Spoken as a primary care doc.

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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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