I asked an internist in a hospital-based primary care clinic if I could follow her for an afternoon. She readily agreed and suggested I might bring a stethoscope. I decided to leave mine stored in the attic and assured her when I arrived that my focus was her and how she worked, not her patients.
The afternoon reminded me of what drew me to clinical medicine in the first place—the privileged connection with patients—and reaffirmed why the barriers and frustrations that get in the way of that connection and lead to burnout are such an important problem to solve.
I was thrilled to see that after 20 years away the basic components of clinical care—history-taking, diagnosis, treatment, and developing a caring relationship with a patient—have changed very little. Yes, the presence of the electronic health record (EHR) is a seismic change from when I trained and practiced, but the connection with the patient and the mystery-solving were the old friends I remembered.
The question burning in my mind as I watched her work was, “How did she do it? How, in the midst of a burnout epidemic, did she manage to remain unscathed and clearly joyful in her work?” During the afternoon I pondered what I’ve learned about the underlying causes of physician burnout to try to answer this question.