Physician burnout has been a much discussed subject in recent years. The term itself is often broadly defined, but the general consensus is that burnout frequently describes a feeling of unhappiness. This unhappiness is often directed towards or fueled by the activities that one has to endure throughout the day, week, or an entire career. Some people have described burnout as having to deal with a series of activities that we dread. In response to physician burnout, hospitals and employers have invested into significant programs to “remediate” their physicians.
I have yet to find any legitimate study supporting the efficacy of these remedial programs, but there is clearly an increase in coaching services, self-help manuals, and aids to combat this growing problem.
The source of physician burnout has been attributed to a multitude of reasons, many stemming from increasing regulatory demands in the workplace, more menial work with electronic health records, and even motivational huddles mandated by administrators to combat the very same problem. There is no doubt that these issues contribute to disgruntled physicians, but there is another problem in our modern healthcare system that is not as commonly discussed.
Your patient is part of the problem
Medical training emphasizes the need to put patients before ourselves. The Hippocratic oath reminds us not to do harm, and we frequently go out of our way in order to get patients the best outcome. In medical school, we undergo simulated scenarios to diffuse conflict. We are taught to emphasize with the patient. Doing so is entirely reasonable and an appropriate exercise for everyone in healthcare, but is it the right approach? Empathy is certainly the socially acceptable answer, but the dark side to empathizing with those we care for is that undoubtedly we end up biting our tongue and perhaps compromising what our moral compass tells us otherwise.
We’ve all had our unpleasant patient and workplace encounters. It’s part of the job, and somehow we’re all expected to brush aside these experiences and continue throughout our days as though it were only a scratch. But we can all attest that the frequency of these encounters has gradually increased over recent years. No matter how insignificant, these battle scars build up. We internalize the pain. We remember the good and the bad cases, and not infrequently, the bad ones are the ones that gall us during our entire career. They cause us to toss and turn in our sleep, disrupt our family lives, and even cause physical ailments.
These unpleasant experiences are uncommonly justified, and they sting. Here are a few scenarios that we end up dealing with in our daily lives:
- A patient demands a refund on their copayment after a visit because they are unhappy for their care. Then they ask for a copy of the visit record. (You can’t legally void a patient visit afterward if you are accepting health insurance.)
- An unreasonable patient lashes out with an unfounded social media review on a 3rd party ratings website. The physician’s office is unable to remove the review because these websites actually hold business reviews hostage. But these websites are quick to push their services onto your practice.
- A patient hammer calls the office with questions that should be asked during a patient visit in order to avoid paying a visit charge.
Medical practice is burning us out
If doctors have always taken care of patients, why are we only burning out now? Two reasons come to mind: (1) the healthcare environment is constantly evolving, and (2) both good and bad information is more readily accessible to the lay public.
The healthcare system is complex. Much of the complexity is due to trying to fund uncontrolled expenses with a finite and insufficient budget. For the workers involved in direct patient care, this has translated into limitations on our resources. Our profession was built on physician autonomy. Physicians have always chosen how to diagnosis ailments, and how to treat them. Our current system imposes strict financially driven boundaries on how physicians can practice. In principle it is great to make healthcare decisions based on prudent cost-saving measures. However, drug formularies are not all created equal. We have all experienced health insurance denials of our recommended treatment regimens only to find that what is recommended by health insurance is not equivalent by any standard. Physicians are now having to fight more than ever with insurers and regulators. This is a mentally and physically exhausting endeavor.
Properly informed patients are a blessing, but there are problems when people are armed with misinformation or are unable to arrive at the appropriate conclusion even with correct information. This situation is increasingly more common with easy access to online information. We see this among healthcare workers as well—we are sometimes armed with the wrong information, but unable to correct our shortcomings due to pride and ego. As physicians we have always struggled with the paternalistic desire to do the right thing, offer the facts, and arrive at the best possible solution for a given situation. It is a struggle whenever we our recommendations do not align with what our patients expect. The patient as a person is not the problem. It’s the availability of unfiltered content open to erroneous interpretation that causes stress. When you throw in the complexities of health insurance that no one truly understand completely, you have are surely going to struggle. Repeated struggles will burn anyone out.
Bringing the sources of burnout to light
Physicians shouldn’t have to dread their work. Our patients don’t deserve to have doctors who are burnt out either. But our current system has made it easy to stress out and find blame. Those of us near the end of our careers can surely attest that practicing medicine just isn’t what it was used to be. It is now up to the current and future generations of physicians to make medicine great again.
What aspects of medicine do you dread?