physician burnout – watercress words by Dr Aletha

The electronic medical record-asset or annoyance?

The increase in physician burnout has been directly linked to the introduction of electronic medical records.

You’re probably used to your doctor’s office using an EMR, electronic medical record (also called EHR, electronic health record) . By now most clinics, private medical offices, hospitals, labs, imaging centers, and other healthcare settings use computers exclusively for everything from scheduling, communication, to documentation and billing. If you are a young adult, you may not even remember a time when medical offices and hospitals used paper records.

Dr. Danielle Ofri, author of several books about healthcare delivery, wrote an astute opinion piece about EMRs for STAT which I encourage you to read. I’m going to review her post adding my own ideas, , with the goal of helping you understand why we doctors, and maybe you, have a love/hate relationship with computers in healthcare; as Dr. Ofri says about electronic health records,

they all have their breathtaking assets and snarling annoyances
Dr. Danielle Ofri

In her piece, Dr. Ofri refers specifically to the use of electronic records in hospitals, but the issues are similar in clinics and other settings.

Breathtaking assets

more efficient storage of records than paper (taking up less physical space and time for sorting and filing)
ability to generate reports
improved hospital efficiency and financial margins (possibly by the ability to analyze data and generate reports)
able to analyze the health needs of large numbers of patients, called population health, so health systems can plan for and offer needed services more efficiently
communication- the ability to contact doctors by email, get test results through a portal, schedule appointments online, order med refills, etc.
legibility and standardization in documentation

Snarling annoyances

changes the way doctors work and make decisions; current software often does not reflect the way doctors are taught to approach patient diagnosis and treatment
less efficient retrieval of data than paper (due to larger amounts of data, which may be redundant)
little evidence yet that use decreases complication rates, or improves patient care in general
less personal interaction with healthcare professionals when communicating through a portal
increased time spent documenting on a computer , much of it simple data entry, compared to writing on paper

But the greatest disadvantages attributed to the use of computers in the medical setting, ones far more than “snarling annoyances” are

interference with doctor patient interaction and communication in the office or bedside; both doctor and patient may pay more attention to the computer than to each other
erosion of staff morale, often due to more time spent on the computer than with the patient, boredom with data entry, and stress of having to learn new systems and updates
contributing to physician burnout, which can have a negative impact on patient care

Doctors like me, who did not grow up in the computer age, went through the entire medical education experience without touching a computer. For us , the transition to computerization while maintaining a busy schedule of patient visits, was difficult and stressful. The increase in physician burnout has been directly linked to the introduction of electronic medical records.

Boldly going…

As Dr. Ofri points out, the EMR is not going away, and few if any of us want to go back to the old system, as annoying as the new system can be. The annoyances are slowly being worked through and resolved, and the assets are becoming truly helpful.

The younger generation of doctors who have never known a world without computers embrace their use readily. As we senior doctors wind down and eventually retire, we can pat ourselves on the back for being the generation that led the way into this strange new world.

a graphic showing various mobile computing devices — a graphic from the LIGHTSTOCK.COM collection, an affiliate

Where you, the patient, fit in

You as a patient have a stake in this endeavor too. As already mentioned, being able to access your records, make appointments, manage payments, and send messages on your computer or mobile device brings efficiency and convenience to a process that formerly was time consuming and cumbersome. I now routinely use my doctor’s office portal for my own medical needs and my patients use my office’s online services . Here’s what you can do to help make EMR use better.

Use whatever online healthcare resources available to you. The more we all use them, the easier they will be to use, and feedback will help developers make them even more helpful.
Be patient with your doctors and other healthcare providers as they transition to EMRs, from one to another, or when problems occur. Like any piece of technology, they don’t always work perfectly, and occasionally they don’t work at all.
Give constructive feedback. A thoughtful critique will help more than irate criticism.

Here is the link to Dr. Ofri’s article-

The EMR has changed the doctor patient relationship into a menage-a-trois

“you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you. ”

from my review of Dr. Ofri’s book -at this link

What Patients Say, What Doctors Hear

Danielle Ofri, M.D., is a physician at Bellevue Hospital, a clinical professor of medicine at the New York University School of Medicine, editor-in-chief of the Bellevue Literary Review, and author of the forthcoming book

When We Do Harm: A Doctor Confronts Medical Error

Another physician explores the EMR

MAN’S 4TH BEST HO$PITAL By Samuel Shem

Samuel Shem (pen name of Stephen Bergman, M.D.) is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His other novels include The House of God, Fine, and Mount Misery .

In this novel about a hospital dominated by computer screens and corrupted by money, an idealistic doctor has one goal: to make medicine humane again. Here is an excerpt-

“Cynical? me? I feed on ideals, on ideal care. I’m so idealistic, to you I sound cynical! And I do not call ’em Electronic Health Records, ’cause they don’t help with health, and may well harm it. With a screen between you and your patient, you get distracted, right? It’s like texting while driving.

So, to remind us of the danger let’s call ’em EMRs, the ‘M’ for “Medical’. “

After a student asks why the computer systems at the VA (Veterans) and the Indian Health Service hospitals, both government agencies, are more user friendly, he goes on to explain,

“Nobody’s makin’ money offa it. So we all gotta get together and unhook care from billing. So nobody makes an obscene profit offa the sick.”

available on Kindle (affiliate link)

exploring the HEART of the health record

I hope you found this discussion enlightening; maybe it answered some questions you had about electronic health records and maybe raised some issues you’d like to know more about. Please contact me with questions and I’ll answer them in a follow up post.

Dr. Aletha

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Why we need a National Doctors’ Day

Along with the honor of being a physician, comes the problem of burnout. Leaders in the medical community recognize the high and increasing rate of burnout in physicians. In burnout, physicians feel exhausted, lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession.

Updated March 27, 2023

Did you know there is a national day to honor physicians? In 1990, the U.S. Congress established a National Doctors’ Day,first celebrated on March 30, 1991.

Along with the honor of being a physician, comes the problem of burnout. Leaders in the medical community recognize the high and increasing rate of burnout in physicians.

National Doctors’ Burnout

In burnout, physicians feel exhausted, lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession.

Statistics suggest that a majority of physicians experience feelings of burnout and compassion fatigue at least sometime during their career. At any given time, that could be your doctor.

Physician burnout can arise from the technological and bureaucratic hassles in medical practice that hinder doctors from spending adequate and quality time with patients and interfere with our ability to care for patients in the way we believe is best.

Studies suggest that burnout causes physicians to spend less time providing direct care to patients, and that care may be less efficient and effective.

Doctors are less likely to experience burnout when they have rewarding relationships with their patients.

Most of us went into medicine because we wanted to help people, and that still brings us the most satisfaction. A successful doctor-patient relationship depends on both persons showing mutual respect.

(And by the way, physicians aren’t the only professionals who can burn out. If you recognize any of the symptoms in yourself, talk to your doctor or a mental health professional.)

The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia. The idea came from a doctor’s wife, Eudora Brown Almond, and the date was the presumed anniversary of the first use of general anesthetic in surgery.

The Barrow County (Georgia) Medical Society Auxiliary proclaimed the day “Doctors’ Day,” which was celebrated by mailing cards to physicians and their wives and by placing flowers on the graves of deceased doctors.

You may not have a chance to honor your doctor in person, but I suggest you commit to doing your part to establish a trusting, respectful relationship with your doctors. It will be good for both of you.

To enhance communication with your doctors-

Be open and honest about your medical history,lifestyle, and concerns.

Sometimes patients leave out important information due to forgetting, thinking it’s not important, embarrassment, or fear. But that may be the very piece of data I need to pinpoint what’s wrong.

So tell the doctor

If you can’t do something you’re asked to do,
if you can’t afford the medication,
if your insurance doesn’t cover something,
if you are afraid to go for the test
if you are seeing other doctors for anything,
how much you smoke,drink, or other habits

Learn more tips on talking with your doctor here-

How to talk to your doctor to improve your medical care

Give details about your problem, explain what you feel

I find that patients often have difficulty describing how they feel. They may say they hurt, cough, itch or get short of breath, but give few details. Maybe because we use text messaging with its brevity, abbreviations and emoticons. We have forgotten how to use descriptive words.

I don’t think we doctors expect our patients to always recite a rehearsed narrative about “why I came to the doctor today.” But it does help if you come prepared to answer questions as specifically as possible. You might try thinking about your problem using the PQRST mnemonic. It will help your doctor identify possible causes for your symptoms, and may also help you understand your problem and even suggest ways you can help yourself.

Find out what PQRST means at this post-

How to tell your doctor what’s wrong with you.

Recognize your doctors are people first

As physicians, our patients’ “social histories” help us understand factors in your life that impact your health -where you live, your job, your family, your hobbies . Besides that, we enjoy getting to know you, especially the things that make you and your life unique and interesting. That feeling can go both ways.

a woman in white coat with mask over mouth

Exchanging a few social words can make the encounter more satisfying for you and your doctor. Some of us will be more open about sharing our personal lives, and some subjects may be off limits. But I don’t think any of us will object to polite, caring interest in our lives outside of medicine.

You may cry when you read about a unique doctor-patient relationship in this post-

A simple way to help your doctor beat burnout

Finally, in honor of Doctors’ Day, meet some physicians with unique experiences to share, just a few of the many doctors who work tirelessly to provide us all with the HEART of health.

Doctors in international healthcare

Dr. Kent Brantly awoke feeling ill- muscle aches, fever, sore throat, headache and nausea. As his condition progressively worsened to include difficulty breathing, he learned the cause of his illness- the Ebola virus. Having spent the past few weeks caring for patients caught up in the Ebola epidemic that swept Liberia in the spring of 2014, Dr. Brantly had contracted the disease himself, and would likely die, as almost all victims do.

Continue this story at-

Surviving Ebola, “Called for Life”– Dr. Kent Brantly

Doctors in disaster healthcare

When she applied for a position in New York City at the NYC Office of the Chief Medical Examiner (OCME), Dr. Judy Melinek never imagined that decision would plunge her into the nightmare of September 11, 2001. She was at the ME office that day when the Twin Towers were attacked and fell, killing thousands of people.

She and the other staff collaborated with the team of investigators who worked night and day identifying remains of the victims, a task she vividly describes in the book. This was basically their only job, since the cause of death was for the most part irrelevant, and impossible to determine. Sometimes they had only a small body part, as little as a finger, to extract DNA to identity a victim. Such identification was critical to bring closure to the families who lost loved ones, people who left for work that day, and never came home.

Read more about Dr. Melinek at this review of her book-

Working Stiff: Two Years, 262 Bodies, and The Making of a Medical Examiner- a review of words worth sharing

Doctors in Primary Care

Melissa Freeman, M.D.- the 91-Year-Old Doctor Who’s the Granddaughter of Slaves

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