Recently, I had an opportunity to drop in on two of the foremost researchers in physician burnout, Sara Poplau and Mark Linzer of Hennepin County Medical Center in Minneapolis. We chatted about various aspects of the current burnout crisis and exciting new initiatives on the horizon. Then we spent some time contemplating a frustrating truth: leaders in health care often fail to acknowledge a reality that leaders in other industries have long embraced: treat your employees well, prioritize their wellbeing and safety, and you will reap benefits in your most important performance goals. It’s a proven strategy for success.
But try to convince board members and the C-suite of a hospital, health system, or large physician practice to free up the resources to prevent burnout and you may find yourself out of breath and red in the face. Despite the fact that burnout costs so much—more medical errors, worse patient satisfaction, less engagement in improvement initiatives the direct costs of recruiting and replacing physicians and nurses who have left—few leaders are ready to invest in prevention. We shook our heads in collective dismay.
Linzer walked to his desk and held up a framed watercolor. Painted by Linzer’s brother, Daryl Wofford, “The Scribe,” depicts three individuals in an exam room: on the right side, a physician and a patient in conversation, and on the left, a young man typing on a laptop.
“This is our goal. This is what we want.” Linzer said. “A physician, freed from typing by the scribe, who is connecting with her patient—and a patient, who is happy because she is getting what she came for—a healing connection with her care provider. Relationships drive satisfaction. And that’s true for patients and care providers.”
I asked about the scribe program at Hennepin County.
When I wrote about the benefits of administrators shadowing frontline clinicians, I felt compelled to look for an opportunity to go to the front lines myself. After all, it has been 20 years since I donned a white coat and stethoscope. I’m firmly entrenched in the identity of writer but know that first hand research is invaluable.
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.
During the Q&A period after a presentation I gave recently on understanding and preventing physician burnout, a physician in the audience voiced her vehement objections to the current electronic health record (EHR) with a simple statement: “We need a revolution.”
In a few words she described her frustrations with the EHR. “It is meaningless—full of fields that we cut and paste from other fields. There are an ever-growing number of pull-down menus and boxes to check, because we are required to document every possible ICD-10 code to make sure the hospital can bill as much as permitted. It leaves me little time to do what I’m there to do: care for my patients.”
Many, many physicians are voicing the same frustrations with the EHR. The negative impact of the EHR is not the only systemic problem fueling physician burnout, but it’s high on the list.
As I drove home from the talk that night, I was struck by how closely the physicians’ experience with the EHR mirrors the central theme of Charles Dickens’ novel, Bleak House. I’m a voracious reader of fiction, although not a huge fan of the classics. But this work made an impact on me that persisted long after I finished my high school English assignment.