Burnout among physicians a pervasive problem that can lead to major medical errors
S E E D E D C O N T E N T
When Dr. Cori Poffenberger curls up on her couch after a long day at work, there's no relaxing. She is an emergency room physician, and at night spends hours filling in patient charts and reviewing test results.
Poffenberger's evening electronic record keeping comes after a full day of seeing patients, teaching medical students, preparing dinner for her family, and putting her children to bed. This after office hours work is what doctors call "pajama time," and experts say it is a leading cause of physician burnout.
"I went into emergency medicine because I wanted to help people," said Poffenberger. "And we've created a system that's taking people who care a lot, and who really feel passionately about this, and making them angry, and apathetic and depressed."
Doctor burnout is a pervasive issue, with more than half of U.S. physicians experiencing "substantial symptoms" of job burnout, according to a 2017 National Academy of Medicine paper.
Dr. Tait Shanafelt, a co-author of the paper, has become a national leader in efforts to curb physician burnout. In 2017, Stanford Medicine hired him as its first chief wellness officer. His job is to find solutions — how do you balance demanding patient portals, long hours and unrelenting record keeping — and still keep up staff morale?
"They're no longer really being empowered to be a doctor, they're becoming a clerk," said Shanafelt. "The answer is not yoga, granola, and getting more sleep."
Shanafelt is taking a holistic approach, with the goal of allowing doctors to focus primarily on their patients as opposed to administrative work.
"We are losing the connection to the meaning and purpose in what we do, which is trying to provide care for patients," he said. "Instead of that, we're actually trying to please an insurance company."
Shanafelt recommends leaders in the medical industry design organizational systems in a way that encourages staff engagement, build and cultivate a community among physicians, remove sources of frustration and inefficiency, and bolster individual wellness.
Poffenberger is all too familiar with burnout. She left a previous job at a community hospital after realizing she was starting to feel apathy toward her patients — a sign of burnout.
"I felt like I had nothing left to give," she said. "A lot of times, that feeling of being appreciated for all you're giving is not there. And then you just, you know, you wonder what's the point?"
Combatting burnout is a high-stakes effort for doctors and patients alike. The suicide rate for physicians is among the highest of any profession , according to a survey by Medscape; more than twice that of the general population.
"We send this message oftentimes that we expect you to be superhuman," said Shanafelt. "That often prevents physicians from asking for help, being vulnerable. And we do need to create safe spaces with low stigma, low barrier, to seek help for physicians."
Physician burnout is dangerous for patients, too.
"Doctors feel that there's a very strong relationship between burnout and the quality of the care they provide patients," said Shanafelt.
According to an analysis of a national study of physicians led by Stanford , more than 10 percent of the doctors admitting they had committed what they considered to be a "major medical error" in the three months before taking the survey.
Hospitals around the country are making changes. At Stanford, Dr. Megan Mahoney oversaw a revamp of family medicine clinics. Now, a so-called scribe deals with records and takes notes during patient visits.
"For the first time in my career I'm able to actually have direct eye contact with my patients," said Mahoney, saying the change has been "transformational."
Allowing doctors to be doctors again, says Shanafelt, is an important step in reversing burnout.
One of Shanafelt's goals is to reduce the clerical burden physicians face, and "allow the physician to focus their time and attention on caring for patients."
Back in the Stanford ER, there's a new reward system for doctors who work extra hours. Poffenberger signs up for ready-to-make meal kits, which means more time with her family.
"I don't want to leave emergency medicine, because I love it," she said. "I just want to make it better."
Tags
Who is online
93 visitors
As one of my daughters is about to embark on her career path to becoming a doctor, everything in this article scares me to death.
Why would we demand that our doctors work these kinds of hours? Why would you want burnt out doctors? What is the benefit of this backward way of thinking?
There is no reason to do this other than tradition. It leads to medical errors and burnout, both of which needed to be avoided. We need 25% more doctors, especially in mental health, so they get the time off that they need and so patients can be seen on a faster basis.
I found a new specialist but I have to wait 60 days to see her. I thought that long wait times only happened in universal healthcare...........
Yep the good doctors are booked months in advance. I waited 4 months to get into a primary care doctor who has a good reputation myself. It was worth it !!
I also had to wait for a specialist for quite sometime. It can be very frustrating. Also, I am not sure what an internist is good for anymore other than vaccinations, a bad virus or bacterial infection. It used to be if I had a bad ear ache, I could go to my doc and they would look in my hear, and give me a dx and some meds. Now I get sent to the ENT. No one thinks of the body holistically.
And yes we are way short on shrinks. My daughter's boyfriend is just about finished with his PhD in Nursing Psychiatry. It took him about 2 min for him to find a job because of the shortage.
I think it's not just the hours. It's also how the hours are spent.
"Pajama time".
It seems to me that doctors are spending a lot more time on documentation and clerical duties than they used to, and therefore have less time for patient care.
Electronic medical records can be a huge help, or a huge hindrance. If it takes you longer to enter the notes for a patient visit than you actually spent with the patient, that's a problem.
Spent way too many years as a paramedic. Eventually became completely burned out.
My daughter is doing that right now, but as a volunteer. Med schools want to see diversity in background and that you are giving back to your community. She looks pretty beat at the end of the weekend.
Been shot, beat, infected, stabbed and broke my back on the job. Not a pleasant way to make a living. Except for the thrill of delivering babies and jump-starting hearts I wouldn't have done it for as long as I did. Way too much death, destruction and danger on a daily basis.
IMO: The american people have themselves to blame. So many malpractices suite were filed the malpractice insurance went sky high pushing many doctors out and keeping many more from becoming doctors in the first place. Doctors are down lawyers are up.
the shortage will probably get worse before it changes.
Malpractice is part of the problem, but it doesn't explain why they are forcing med students to work these ridiculous hours.
Not too long ago they went to 12 hour shifts for much of the medical field in hospitals and nursing homes.
I had just finished getting my CNA licence, at my age I was not willing to work 12 hour shifts so I took a step back and did caregiving work instead where I could pick my own hours.
What a waste of my time, effort and money !
Once was a lowly EMT on a small county ambulance service where I had to work 48 on 48 off. Fell asleep on top of a patient once. Luckily he was still alive when we got to the ER 45 miles away.
What was the management logic of working people well past human tolerance?
The idea is that you'll not likely be working the whole time, and you'll sleep between calls. Emergencies don't always agree with that concept.
So basically this is simply 'on call' for two days rather than 'on duty' for 48 hours straight?
Different things at different hospitals. Some make their docs sleep in doc on call rooms so they can only get catnaps.
Not really. EMTs here sleep and eat at their stations. They're expected to do station and equipment maintenance and training. But if all of their duties are finished, and they haven't been dispatched, they can sleep. Sometimes they get a full night's sleep, and sometimes they don't.
EMTs in my area don't pull 48-hour shifts, though. They do 24-hour shifts, which might run over if they're working an incident when their shift is up.
This is the main reason that I stick with a midewiwin (medicine man)....
Strange the truck drivers are subject to strict Hours of Service rules but Doctors are not
During my internship I'd be awake for days on end. When I finally crashed and burned, nothing short of epi could wake me.
Not surprised.
Yeah, kind of tells you about our priorities.
Not to slam the elderly as I am one, But I also learned to seek a middle aged doctor , one who has more modern training and some experience to learn how to use it.
At one time I was going to an older chiropractor after an on the job accident, I saw him for two years 3 times a week he finally rated me at 65% disabled. At 22 years of age that was unacceptable to me, I found a younger more recently educated chiropractor, he took me back up to being only about 5 % disabled. 95% all better...That's the difference !
This is not my only experience with this old dr verse younger dr stuff, I did caregiving with disabled veterans for years I saw lots of doctors and saw the same thing happening with others, Some other people when faced with this I've convinced to seek another or a second opinion, some I didn't. The ones who did were happy they did.
I got pretty good at sizing up doctors pretty quickly for myself and these guys, maybe because I saw and dealt with so many doctors.
Modern Medicine is changing so quickly, why not get the newest treatment that you can ?
Well, yeah.
yep sounds logical eh ?
But, You wouldn't believe how many people won't change doctors for anything, Some would rather die first.
Not even a second opinion from so many.
I learned my lesson !! If an old doctor sees me, its the last time for me at that office now.
Sorry if that's predigest. I really dont care, I have my reason for my believes and behaviors.
I want to live.
Oh I know. People get to comfortable with their docs and then die from that. I have seen that several times in my life.
Health is not to be messed with. If you feel that you are not being heard or you have a gut feeling get a second opinion.. a third.. do your own research. If the doctor doesn't explain things to you in detail, find a new doc.
You bet. and the right doctor is the key.
My own mom was so set on one of her doctors she insisted she go to him when she broke her arm, I tried to get her to go to a different doctor, she would have nothing to do with it, till her doctor almost threw her out of his office, He was a cardiologist.
And he was none to happy she had wasted his time.
That's alzheimer's for ya.
BINGO!
US medical system and those who work in it have been under assault for decades by the for profit insurance industry. The insurance industry respects nobody, cares about nobody and its only concern is profit for those who contribute nothing for better outcomes and working conditions. Until that changes the spiral downward in health care will continue while the expense of healthcare will increase.
Well I won't fight you there. But it's not only insurance, it's hospitals who charge you $100 for an aspirin, and Big Pharm, who have college students do all the R&D by giving a big endowment to schools which are then written off as a tax deduction for charity. I could just go on and on..
Which I think they started doing to cover for those they treated with no insurance, Why didn't that change after the ACA was enacted like I thought it would.
sarc
False. The government is not the problem. The problem is the private for profits.
If the government is so bad------------why won't the republicans abolish The Veterans Administration, Medicare, Social Security, Medicaid and all the rest?
Government is not the problem and never was. The problem is the private for profits involved in our broken arms, general illness and regular health maintenance. I remember what going to the Doctor and hospital was like before Reagan.
$100 for an aspirin? Yes, I suppose there is that.
But, in Jan. 2014 I slipped on the ice and compound fractured my hand and wrist. Was in the hospital less than 24 hours, had surgery. The bill was $56,000. My insurance settled for $31,000. My out of pocket was almost $1900.
I was born in 1947 and along with my birth certificate I have the hospital bill. The bill was $72.00 out the door. What has happened to our healthcare?
Today, there are people with 'crap insurance plans' that get sick or injured and have to file bankruptcy. In my opinion, this is immoral and reflects very poorly on our nation. ( And as for those insurance carriers that 'sell those crap policies,' I think all of their executives should be bankrupted and jailed. ) That would end that problem immediately. Besides, the insurance industry pays it's executives far----far more than they are worth. And we are paying the bill. The insurance industry is the reason for high healthcare costs. We are paying for them and they do nothing for us. Nothing.
So all you have to offer is saying that it's the left's fault without making your case. I can prove mine, can you prove yours? And for the record, I am very informed on this, since my family is mostly in medicine, and I am not "left wing". Bring an argument with some actual facts.
This is true, but they can't afford better insurance. Right now we are paying out of pocket for our insurance, which is good insurance and it cost $2,300 a month. Luckily we were prepared for this, but most people are not. The insurance companies, the drug companies and the hospitals are both charging insane amounts of money for care.
btw... $72.00 in 1947 adjusted for inflation is $846, which is a bargain by today standards, but then again, OB's were not getting sued left and right, which is a huge part of the problem.