February 16, 2016

Fighting Burnout In Medicine

By The Diane Rehm Show Staff

Medical personnel simulate emergency treatment during a mass casualty exercise at Balad's Air Force Theater Hospital.

Medical personnel simulate emergency treatment during a mass casualty exercise at Balad's Air Force Theater Hospital.

On Tuesday, Feb. 9, our panel discussed how technology is changing doctor-patient communication. Many of you asked in your calls, emails, tweets, and Facebook messages whether more digital communication with our healthcare providers could worsen doctor burnout. While we touched on this during the show, one of our guests, Dr. Saul J. Weiner, hoped to go more in depth on the topic. He shares his thoughts on burnout, and how to address it, below.

Physicians spend a long day in the office and then come home to a packed inbox of messages from patients to respond to, plus extensive paperwork related to their practice. Better routing of these tasks to individuals who are designated to manage them is part of the solution, such as putting the doctor in charge of a team, of which one member triages responsibilities.

This routing process can be facilitated with technology. During the show, I mentioned that the Department of Veterans Affairs has introduced secure messaging tools not only for patients to communicate with doctors but for health care teams, comprised of clerical staff, nurses, pharmacists, social workers and physicians to team up online to divvy up work. Many challenges to making this process entirely successful remain, but it’s a step in the right direction.

I do think, however, that there is another major contributor to burnout that is often not discussed or acknowledged. For most people, work is fulfilling when there is meaningful engagement. The best moments for me as a physician are when I’m completely absorbed trying to help a patient figure out what to do next. In these moments I’m not thinking of myself as “the doctor” and I’m not thinking of them as “the patient.” It’s just me giving another person my full attention with the aim of figuring out what is really going on with them, and how best I can assist.

In our book Listening for What Matters: Avoiding Contextual Errors in Healthcare, we describe what we’ve heard while listening to over a thousand covertly collected audio recordings between physicians and patients (in some cases the patients were “fake,” meaning we’d sent in actors to portray particular clinical situations). Too often we hear a task-oriented interaction, in which the doctor is trying to get through a list of items required to meet billing requirements or other expectations, usually requiring data entry in the computer record. For example, if the patient says something revealing like “Boy, it’s been tough since I’ve lost my job,” a preoccupied physician might reply, “I see, and do you have any allergies?”

Some doctors seem inherently more inclined to engage with patients than others. The ones who engage seem unselfconsciously curious about the lives of their patients. Every visit is different. Others are inherently task-focused. They tend to lecture patients more, rather than asking questions. Each visit they say the same things over and over again. Just imagining what that must be like is fatiguing.

Not long ago, I stayed with my wife at a bed & breakfast that had been run by the same owners for 20 years. Twenty years is four times the average length of time before a B&B changes hands. Having different folks come through your house every day, serving them breakfast and telling them about the tourist sites in town day in and day out can lead to burnout — but this couple clearly still loved what they do. I was fascinated and wrote a column about them that explored why they weren’t burning out. Although we were only there 18 hours and were probably one of several thousand guests they’ve hosted, they were fully engaged, which — paradoxically, because it seemingly requires greater effort — may be an antidote to burnout.

The computer is a part of the problem, but it’s not the whole problem. Ideally we’ll find a way to maximize the use of technology and teamwork to manage the task-oriented aspects of care so that face-to-face interactions can be fully engaged, bringing meaning to the professional life of the doctor and value to patient who seeks to be known and cared for as the individual that they are.

Dr. Saul J. Weiner is a professor of medicine, pediatrics, and medical education at the University of Illinois at Chicago and thedeputy director of the VA Center of Innovation for Complex Chronic Healthcare. He recently co-authored a book called “Listening for What Matters: Avoiding Contextual Errors in Healthcare.”


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