Most doctors I know can’t conceive of doing any more of anything.
Their patient visit slots are completely maxed out. Lunch is nonexistent. Every day, it seems like managers and administrators have a new request, demand, or memo to share about yet another thing that must happen during the visit, during the workday or at home.
So a recent article in Fierce Healthcare made me both nod in recognition and cringe with concern.
The takeaway of the article is that patients wished their doctors would talk to them about — and perhaps even support them with — more non-medical or quasi-medical issues. The Harris Poll surveyed over two thousand adults. Those adults shared that doctors (of course), tend to focus on physical health, even though the most common health issues were actually depression, anxiety, chronic pain, and diabetes. According to the poll, however, doctors touched on the mental, behavioral, or spiritual components of health, less than half as frequently (sometimes as little as 10% of the time), as more cut-and-dried physical components of health.
Of course, these “soft” elements — mental, behavioral, or spiritual components of health — are often the things (like exercise, sleep, etc) that can prevent illness or treat chronic conditions. Also, they often relate more intimately to issues like addiction or suicide which are, of course, epidemic in the US. So it could be deeply helpful to patients if doctors were able to broach more of these subjects.
“With what time?!” I can hear doctors exclaiming in my head. I know from experience that within the visit time allotted by our bosses and by the healthcare industry, it’s difficult to cover even the basics of the patient's complaint and to satisfy all of the EMR’s buttons and requests. When we read an article like this, we feel like one more thing is being demanded from us that may as well just be deducted directly from our sanity.
Interestingly, an article in the New York Times that came out around the same time looked at doctor burnout and may indicate different conclusions. Dr. Mukherjee reminds us that burnout can be predicted by three things (termed the “Maslach Inventory”):
- Emotional exhaustion (being “chronically overextended”)
- Depersonalization (“becoming disconnected from the recipient of your services”)
- Lack of personal accomplishment “a feeling that nothing is being achieved.”
Ironically (or perhaps predictably), the very things that our patients want more of from us — more engagement, more deep interaction, more holistic care — are the very things that would keep us from getting burned out. And so perhaps there is a bit of a chicken-and-egg situation. We feel overworked (emotional exhaustion), so we pull away from the personalization and sense of personal accomplishment that would keep us from getting drained. In the process, we miss the very things that could treat our patients more meaningfully.
It's true that most elements of the medical system right now do not support us in this pursuit. Productivity metrics, EMRs, and decreasing visit times all hinder us in this kind of approach. But the truth is that we still have the autonomy to take an extra 45 seconds and ask that softer question. Or to try a new medical collaboration tool for a week, if we think it would help us feel supported by our colleagues and give us some followup. The changes, perhaps, don't need to be as dramatic as one might initially think -- to be deeply satisfying to both our patients and to ourselves.