Search Results for 'Physician burnout'

The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers

Too many specific theories about physician burnout can cloud the real issue and allow healthcare leaders to circle around the “elephant in the room”.

The cause of physician burnout isn’t just the EMRs, Meaningful Use, CMS regulations, the chronic disease epidemic or any other single item.

Instead, it is simply this: Healthcare today has no clear definition of what a physician is. We are more or less suddenly finding ourselves on a playing field, tackled and hollered at, without knowing what sport we are playing and what the rules are.

Historically, physicians have been viewed as professionals and also, more lately, as skilled workers. But we are more and more viewed and treated as neither. Therein lies the problem.

The way professionals are treated is this: You present them with a problem and they use their knowledge to solve that problem Since they know more than the requester, they aren’t micromanaged. They usually also set their fees and determine the time needed to realistically finish he job.

Skilled workers are asked to apply knowledge and workflows to relatively strictly defined tasks and it is the employer’s responsibility to make sure they have what they need to finish the job. If the tasks are unrealistic, the manager is held responsible: If the assembly line is moving too fast and the majority of workers end up passing on unfinished product or start pulling it off the line to finish later at home, the manager is likely to take the consequences. No one is likely to say that all workers, individually, are responsible for such chaos.

But in today’s healthcare, we have a rapidly moving assembly line. The foremen blame the workers for not attaching all the parts or not keeping up with the workload. Upper management doesn’t always take full responsibility, instead shrugging and saying: “it isn’t our problem, they’re professionals, they should be able to figure this out”.

Put simply: If anybody wants to define and manage our work for us instead of letting us do it, they become responsible for the outcomes if we aren’t given the time or the tools we, as the ones who went to school, know we need.

The cure for physician burnout is simple: Listen to us when we say what we need in order to do our best. We didn’t spend all this time and energy so we could collect our salaries and goof off.

Most of us still have a professional mindset. We want to do a good job and we know how to do it. Let us.

A Country Doctor Reads: What if Burnout Is Less About Work and More About Isolation? (NYT)

This weekend I read a piece in The New York Times that put a slightly different slant on what burnout, in the case of physician burnout, is or is caused by. We have heard theories from being asked to do the wrong thing, like data entry, to “moral injury” to my favorite, “burnout skills“, when you keep trying to do the impossible because people praise you when you pull it off.

Tish Harrison Warren’s piece is a dialog between her and psychiatrist/author Curt Thompson. He focuses on isolation as a driver of burnout:

Assume that if you’re burned out, your brain needs the help of another brain. Your brain is not going to be OK until or unless you have the experience and opportunity of being in the presence of someone else who can begin to ask you the kind of questions that will allow you to name the things that you’re experiencing.

The moment that you start to tell your story vulnerably to someone else, and that person meets you with empathy — without trying to fix your loneliness, without trying to fix your shame — your entire body will begin to change. Not all at once. But you feel distinctly different.

I’m not as lonely in that moment because you are with me. And I sense you sensing me. That’s a neural reality.

I have written about burnout many times. The NYT article made me remember that I once also wrote about missing the doctors lounge and how I once tried to start a slack group among my colleagues. It never really took off but I think the point about isolation feeding burnout is very valid. Back when there were doctors lounges, we would talk with colleagues. Even in the office when I started out we scribbled our chart notes very quickly and then we would have time and space to discuss our cases or other things with our colleagues. Now we are tied to the computers, feeding the big machine that controls each of our lives.

As often before, my thoughts go to a James Taylor song, one about working in isolation to feed a big machine – Millworker:

Then it’s me and my machine

For the rest of the morning

For the rest of the afternoon

And the rest of my life

And, later:

And I have been the fool

To let this manufacturer

Use my body for a tool

But, when all is said and done, I am not burned out, as I say in one of my videos. I work at looking beyond my obstacles and I focus on my patient encounters and my curiosity.

But I wish I wasn’t as isolated as I am, in part simply due to the pandemic. I mean, even medical staff meetings are virtual these days. Like Hollywood Squares…

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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”.

BOOKS BY HANS DUVEFELT, MD

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