In theory, none of us SHOULD need to do medical collaboration. In an ideal world, each healthcare provider has perfect knowledge of every disease and impeccably up-to-date information on their patient, at all times.

The reality? Each healthcare provider has a rich, powerful, and incomplete perspective. That means that the super-specialist and the aide both have a crucial role to play. And that the more we communicate with each other about our patients, the more fully we can help them.

It’s not often you have precise confirmation of this reality. But a recent article in JAMA put a spotlight on it for me.

One of the more routine things we do as doctors is recommend cancer screenings. It’s not the most sophisticated analysis; it’s not the most intense moment. But it is important and absolutely does save lives.

As routine as this may be, however, it is still powerfully impacted by the real limitations we have as busy, human people who are acting within a context of too-short visits and too-hectic care contexts. In fact, this recent study by the University of Pennsylvania, and published by JAMA, shows that "As the overall clinic day progresses, clinicians may face decision fatigue, defined as the depletion of self-control and active initiative that results from the cumulative burden of decision making"' and that "Relative to 8 am, the adjusted odds ratios (OR) of clinician ordering and patient completion of breast cancer screening was significantly lower for each hour from 10 am to 5 pm."

In other words, even the most fundamental aspects of the care we provide are impacted by our own energy levels and the context in which we see the patient. 

This isn't shocking; it is completely natural and human. But — it’s our responsibility to support ourselves so that every patient we see gets the same standard of care. Just as it is our responsibility to wash our hands, it is our responsibility to get the collaboration and support we need from colleagues through telemedicine-based medical collaboration. We can't fix the healthcare system. But we can make sure that we have the tools we need to work effectively within it — every hour of the day. 

 

Get the support you need with iClickCare. Try it for free: 

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.”

I think many of us tend to talk about and experience the first one — that of being chronically overextended. But the truth is that depersonalization and lack of personal accomplishment are equally important to remaining satisfied and having longevity in our work.

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.

 

Many healthcare providers feel undervalued, unappreciated, and overworked.

(“Yeah,” I can hear you saying, “Name one provider that doesn’t feel that way!”)

I know that for many providers, it feels like their work is disposable, that it’s not valuable, and that they’re a cog in the wheel.

In reality, however, healthcare providers are in short supply and of extreme value to hospitals. In fact, the cost of replacing a physician is estimated to be $500,000 to $1 million. And Fierce Healthcare reports that the provider shortage is bad and getting worse. They quote Bill Haylon, CEO of Leaders for Today as saying, “The findings tell us is that there simply isn’t enough qualified talent to go around and that frustration levels are rising."

So you would think that the healthcare system, in particular major hospitals, would be "all hands on deck" to retain their healthcare providers and to leverage their time and expertise.

In reality, my observation is that hospitals simply aren't doing enough to retain their providers. In 2014, 54% of U.S. physicians reported burnout, much of their frustration coming from ever-increasing clerical loads. Of course, physicians with symptoms of burnout are more likely to report having made a major medical error in the past 3 months and to receive lower patient-satisfaction scores. Many, perhaps most, feel under-appreciated, under-supported, and overworked.

Further, most medical practices and hospital systems are not leveraging their providers' time with hybrid store-and-forward telemedicine or healthcare collaboration. The pressure on providers to perform at the highest levels, with no mistakes, is high. But the tools provided to support care coordination or healthcare collaboration -- which can reduce workload, and decreased mistakes, while easing burnout -- are inadequate. 

We believe that the key challenge here is for us to connect the dots. We need to connect the dots between hiring challenges that hospital administrators face... and burnout... and the lack of healthcare collaboration tools that can significantly leverage providers time, and ease burnout. Ultimately, the right tools -- like healthcare collaboration using iClickCare Hybrid Store-and-Forward® -- can make the challenges around the provider shortage much less severe.

To learn more about how to start a program at your hospital, download our free guide: 

A common critique of healthcare collaboration in general — and iClickCare in particular — is that it will never become widespread because doctors are too rational and self-centered to do something “altruistic.”

We’ve even seen hospital administrators make widespread strategy decisions with the assumption that doctors care most about money and status and “what’s in it for me.”

That perspective never resonated with us. And we’ve seen hundreds of people thrive with iClickCare, both because it saves them time, has a great ROI, and for the “altruistic” reason that it is better for their patients. But it wasn’t until today that our hunch was truly confirmed by a medical journal.

The New England Journal of Medicine published two articles recently that dig into the phenomenon of burnout and debunk a lot of myths we have about it — ultimately getting at what motivates doctors.

In “To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis,”  Dzau et al. look at the causes and manifestations of burnout.

Of course, the consequences of allowing burnout to persist are serious:

• Physician suicide.
• Patient safety. “Some studies have revealed links between clinician burnout and increased rates of medical errors, malpractice suits, and health care–associated infections.”
• Costs to productivity. “In one longitudinal study, the investigators calculated that annual productivity loss in the United States that is attributable to burnout may be equivalent to eliminating the graduating classes of seven medical schools.”

It's a critical problem that demands real solutions. As for what those solutions should be, common wisdom is that doctors need more time, money, or efficiency.

But as Dzau et al. share, in many cases, what doctors really need more of is connection to the meaning and fulfillment in their work. “The ethical principles that guide clinical care — a commitment to benefiting the patient, avoiding harm, respecting patient autonomy, and striving for justice in health care — affirm the moral foundation and deep meaning underlying many clinicians’ views of their profession as a worthy and gratifying calling… Clinicians are human, and it takes a personal toll on them when circumstances make it difficult to fulfill their ethical commitments and deliver the best possible care.”

So although people sometimes challenge iClickCare on the grounds that doctors are too rational or self-centered to use it, iClickCare allows doctors to connect with colleagues, do healthcare collaboration and care coordination, and make better diagnoses and fewer mistakes. In other words, iClickCare connects directly to doctors' sense of fulfilling their ethical commitments and delivering the best possible care. And in doing so, iClickCare relates directly to easing burnout.

In “Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians,” Wright and Katz quote Dr. Christine Sinsky as saying, “We’re spending our days doing the wrong work. At the highest level, we are disconnected from our purpose and have lost touch with the things that give joy and meaning to our work.” Doctors spend 1-2 hours doing the clerical or administrative work for every hour they see patients. (Patients who are often double-booked, back to back.) As high achievers, they fit this work into spaces in their day that don’t exist. Administrators, facing their own severe pressures, aren’t compensating doctors for this "around the edges" time and they are not giving them the tools they need to feel, and be, supported in the work.

The demands on doctors increase, but with decreasing access to the parts of the job that fulfill them — decreasing access to the parts of the job that keep a doctor from burning out. 

David Whyte, the poet, says: "The antidote to exhaustion may not be rest. It may be wholeheartedness." And ultimately, when we think about iClickCare, we're motivated to help doctors find that wholeheartedness in their work. You don't need your hospital's support and you don't need all of your colleagues to take it on. All you need to do is to make the tiny choice to act on your own behalf. 

Downloading iClickCare takes 10 seconds and is free. Try it today:

In medical training, for better or worse, we are trained to put our patients’ needs above our own. Whether you are tired, or your back hurts, you finish the surgery; you complete the rounds.

To some extent, the biggest value of our medical training isn’t the facts and methodologies. It’s that we’re taught to be true physicians (or true nurses, true therapists, or true aides). We’re taught to be scientists, artists, and caregivers in equal measure — we’re taught to be the ultimate professionals.

But this exquisite professionalism can go too far, especially when it is combined with the current climate of productivity obsession. The high principle of the medical training becomes combined with the drive to cut costs and produce more. And then the dominant narrative is that providers need to produce more, always do more... the more they subsume their own needs to the needs of their patient, the better.

But two new studies made me stop and question whether anyone is benefitting from this extreme. This study shows that nurses suffer depression at twice the rate of the general population. As Fierce Healthcare reports, “The attitude that "nurses don't crack" and a culture of constantly hiding one's emotions only ends up causing the problems of depression and anxiety to multiply and in the end can compromise patient safety and drive good nurses out of the profession.” That’s distressing in itself. But further studies show that nurses suffering from depression or burnout are more likely to make a medical error.

Our takeaway? There really isn’t a separation between who you are as a human being, and who you are as a healthcare provider. And that’s a good thing. Medicine is an art, a science, and a calling. And for us to be fully present for our patients, we need to be fully present with our whole selves. Which means we need to have our needs as people met.

Similarly, our patients are people with lives outside of their medical condition. And for us to fully minister to their needs, we need to understand the context within which they live... emotionally, societally, financially, physically, and spiritually.

It’s been shown that when we feel isolated — like when we don’t connect with our colleagues — we experience anxiety and depression. And studies are showing that when we don’t feel connected with out patients, our burnout increases. 

Sure, perhaps it would be better if we could return to a different era of medicine, one in which healthcare providers had the time and support to connect with each other and slow the pace of care.

But realistically, the pace of medicine may stay as relentless as it is. And so we must use tools that allow us to connect with each other within the constraints we have, like telemedicine-based healthcare collaboration, to support ourselves — and each other.

To feel more connected with your colleagues, try iClickCare for free, from the App Store:

We talk a lot about medical collaboration. The best healthcare providers know that we give better care when we work together. Medical collaboration lets us make better diagnoses, do care coordination more effectively, teach the next generation of providers, and prevent patients or findings from falling between the cracks.

And we don't have hard data on it, but all signs point toward providers being increasingly "siloed." Specialization increases every year. The amount of time that we have to discuss a good case with a colleague is non-existent. The disincentives (HIPAA, etc) that exist to work with other providers increase all the time.

But it's often hard to pin down the ways that this is happening, and to what extent. An interesting parallel to this dynamic is the polarization we are seeing in our political system. We hear a lot of talk about how there is a lot of division and polarization in the US political context, but similarly, we often can't pinned down whether this is really true, and to what extent.

So I was fascinated to see an academic study that quantified and visualized the level of cooperation between Democrats and Republicans in the U.S. House of Representatives from 1949 until 2012.

Their findings were pretty stark: "We find that despite short-term fluctuations, partisanship or non-cooperation in the U.S. Congress has been increasing exponentially for over 60 years with no sign of abating or reversing. Yet, a group of representatives continue to cooperate across party lines despite growing partisanship." This image shows the ways that the polarization has occurred over that period of time. Each dot is a representative, and lines connecting pairs of representatives who vote together. The dots for each representative are placed according to how frequently the Representatives vote together overall.

As I said we don't have hard data about it, but our anecdotal observation is that polarization, non-cooperation, and siloing of healthcare providers has also risen exponentially, during about the same time period. 

And just as US citizens suffer when politicians don't cooperate, patients suffer when providers don't collaborate. Here's why:

1. Trust, satisfaction, and sustainability degrade. Cooperation and collaboration are valuable ends in themselves for the mental health and efficacy of healthcare providers. With so many healthcare providers suffering from burnout, feeling separate from each other and our patients can hurt our health, our sustainability as providers, and our performance.

2. Results aren't as good. Whether it is the citizens of the US or our patients that we're talking about, our results can be very poor when we don't work together effectively. Medical collaboration isn't a "nice to have" -- it's a crucial component of providing the best possible standard of care.

 

Ultimately, the only solution to fixing the polarization problem is to start drawing more lines between more congresspeople (in the case of politics) and between our colleagues in the medical world. It is said that "there is no path; the path is made by walking." Similarly, the only way to a more connected and cooperative world is by connecting and cooperating. We can give you the telemedicine tool -- and it's up to you to do it. 

 

Many of us think of social connection as something that's nice, but certainly not a must-have for our health. But new research turns those assumptions upside down, showing that for older people, being lonely and socially isolated can have a powerfully negative impact of their health and longevity.

A few days ago, the New York Times summarized several studies showing that elders with social isolation and loneliness experience higher mortality rates and an increased risk of depression, in addition to cognitive decline and other illnesses.From the standpoint of a medical provider, this has important implications for how we look at the care and healing of patients in Long Term Care. If being isolated and cut off from support networks can make patients sicker, perhaps we think twice when it comes to moving a patient, or have them bounce around from doctor to doctor. Perhaps we use medical collaboration tools more frequently so that doctors collaborate on the patient's behalf, while they stay in their social context. Of course, even simple connections -- like a card game or a conversation with an old friend by phone -- seem to make a big difference when it comes to these risks. So, many times, we just need to let our medical care "get out of the way" so simple connections can happen for patients.

The studies also reminded us of the impact of loneliness and social isolation for medical providers themselves. About 50% of doctors end up experiencing symptoms of burnout in their career. Studies like this one show that feeling cut off or detached from patients contributes to a sense of burnout. Unfortunately, so much in our practices contributes to distraction and disconnection -- which ultimately exacerbates burnout as well. 

Just as it is important for older Americans to find ways to connect, to maintain their health -- it is important for doctors to find ways to connect to each other and to patients. There is so much that takes our time, as healthcare providers. But, as this research reminds us, connection is crucial to the long-term sustainability of our practices, our patients and, of course, our own health.

It's not always easy or initially obvious, but it is crucial.

Learn more here about how iClickCare can make medical collaboration faster and easier:

Speakers at the Institute for Healthcare Improvement (IHI) 28th annual National Forum had some interesting insights about healthcare provider burnout and healthcare collaboration.

Dr. Carly Busman at Northwell Health, says they are finding that even simple team-building exercises improve "morale, communication and increase trust, which improves teamwork and productivity." And in an era when half of providers are burned out, improved morale and trust can by the clincher for everything from productivity to cost reduction.

The activities Northwell Health implemented included laser tag and rope courses. Our first reaction when we heard about it: skepticism. For busy healthcare providers facing life and death decisions in addition to family pressures, the idea of taking a Saturday morning to play laser tag seems fool hardy at best and disrespectful at worst.

So we were surprised to learn that despite the inadequate-seeming nature of these activities, they showed real benefits to the team and to the providers as individuals. 

We think there are several key lessons from both the strengths and the weaknesses of this project:

• A little connection can go a long way. We are so isolated from each other as healthcare providers that even a few simple activities can dramatically improve our sense of well-being as professionals.
• Patient satisfaction comes from provider satisfaction. Healthcare is too focused on patient satisfaction and patient satisfaction comes from happy providers. This type of project proves that there are big rewards from ensuring that healthcare providers get what they need first.
• It doesn't have to be complicated. Many of these activities just amounted to the cost of pizza and soda... and high-impact team-building doesn't have to be sophisticated or expensive.  That is why we made sure the iClickCare works on the smartphone, for ease of use.
• Meaningful collaboration is even better than simple team-building. Even when limited to simple team-building, this project saw results. We've found that meaningful healthcare collaboration -- in which healthcare providers have the tools they need to consult with each other, talk about cases, support each other, and contribute to patient goals together -- can have many multiples of the impact.  

We applaud Northwell Health for their initiative in supporting healthcare providers in connecting with each other.

And we encourage our colleagues across hospital systems to "think small" when it comes to healthcare collaboration. Use the devices and tools available to you; try a small pilot of a new technology or practice; and don't forget that productivity usually comes from happy providers.

If you want to explore medical collaboration, we put together a free guide with tips, stories, and ways to do medical collaboration in your own organization: 

With all the griping about medicine that happens these days, it's shocking when anything is positive, much less, overwhelmingly positive.

That's why we really enjoyed Dr. Danielle Ofri's article in the New York Times recently about one thing that remains very, very positive in healthcare today:
90% of patients are satisfied by their relationship with their primary care doctor.

So many healthcare providers are jaded by the system. They've decided that medicine is a job like any other, in an industry like any other -- and the way to succeed is by minimizing their hours at work and maximizing their pay check.

We can understand where those folks are coming from. But the thing that differentiates our colleagues who use iClickCare is that they have chosen not to go down this road. Our colleagues who use iClickCare have made the choice that medicine is a calling, not a job. They decided that it's an art and a science, not a set of rules to carry out. And although iClickCare makes sense in terms of dollars and cents, most people who use iClickCare use it because it connects them to other providers and helps them serve their patients better. In other words, because it brings them joy.

Healthcare provider burnout is bad and getting worse. But working less won't help and neither will making more money. Interestingly, the data is very clear: connecting more with colleagues and the satisfcation of caring for your patients will make you happier and healthier as a medical provider. 

As Dr. Ofri says about medicine: "The awe of discovering the human body, the honor of being trusted to give advice, the gratification of helping someone through a difficult illness, the intellectual stimulation of continually learning — these things never grow old… We doctors… shouldn't be afraid to speak up about what's right [about medicine.]"

We remain inspired by those doctors who tap into that awe every day, and by those who speak up about what is right about medicine -- and how we can do more of it. 

 

To give telemedicine a try for free, click here: