Fixing the health care system

For all the talk about health care reform, improving care coordination, increasing patient satisfaction, and reducing costs, maybe it all doesn’t matter if our nation’s physicians don’t “feel the love” … so to speak.  After all, physicians (although not their salaries) account for a large proportion of both direct and indirect medical costs in the United States.  Physicians largely remain the gatekeepers to further care in this country; 85% of health care costs can be directly or indirectly linked to the doctor’s pen, keyboard, or mouse.

Dr. Pauline Chen comments on the physician burnout phenomenon in her New York Times blog about a recent study of over 7000 physicians and how fulfilled they felt in their careers.

Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors’ responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.

Chen notes that burnout seemed highly correlated with front-line access to care – more than half of physicians who worked in general internal medicine, family medicine, or emergency medicine experienced burnout.

More importantly Chen comments on why the rest of us should care; doctor burnout directly related to quality of care and patient safety.

What patients must face in the examining room is no less alarming. Doctors who are suffering from burnout are more prone to errors, less empathetic and more likely to treat patients like diagnoses or objects. They are also more likely to quit practicing altogether, a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.

I’ve certainly experienced burnout during my residency training, and while that statement should bother you, it shouldn’t be surprising.  Most people cant imagine working 30 hours in a row.  I’ll provide real world examples of how it might feel to you.  Imagine you receive 400 emails a day – how much effort and time do you put into emails #399 and 400?  Or maybe you work in the restaurant industry – not only have you been on your feet all day, but the hostess just put sat a new table in your section even though you’re due to end your shift in 5 minutes.

But we’re physicians after all – held to a higher standard even though we are undoubtedly not supermen nor superwomen but merely mortals like everyone else.  The higher standard means we should care more, and every patient should be treated equally… right?  In an ideal world this is true, and even in the not so ideal world that we actually operate in this should be the standard to which we hold ourselves.  But that standard falls apart when you are working hour 29 of 30 with no sleep.

I will fully admit that I’ve found myself at 5:30am in the Emergency Department not caring about what ails the 20th patient I’ve seen that night who happens in front of me complaining of non-specific abdominal pain with no obvious source.  I have definitely answered a page to drain an abscess in the ER only to turn over and set the alarm on my phone for 20 minutes later just to catch some sleep.  I’ve definitely given responsibility over following up a lab value or radiologic exam to an intern so that I could relax for 10 minutes or so.  I’m not proud of those moments – but fact of the matter is they occur.

I always assumed that those moments would end after residency, when the patients were actually MY patients and the hours were not as grueling.  But the research article that Chen cites seems to suggest that it may not get better.  And that delays in care, poor coordination, and management errors may in fact continue long after the rigorous training of residency comes to a close.  And if so, all the health care reform in the world may not fix the problem if, in fact, the problem that needs to be fixed is motivating physicians.

So what do you think?  Do doctors just need to suck it up or do we have a real problem in the physician work force?  Because the repercussions could be critical…

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About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
This entry was posted in medicine, newspaper and tagged , . Bookmark the permalink.

One Response to Fixing the health care system

  1. BosGuy Blog says:

    No easy answer to the question you pose or the dilemma that is facing all hospitals and doctors. However, ignoring the situation doesn’t make the problem go away. Early detection and prevention is the key — isn’t that how the saying goes in health care? Great post J.

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