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.
Physicians have long been seen as superhuman—able to jump the academic hurdles required to gain entrance to medical school, willingly delaying many of the gratifications associated with young adulthood, surviving long hours during training and later when in practice, keeping a cool head amidst crisis.
In many ways, we physicians thrive on this image. Personally, I was unaware of how much I enjoyed the mantle of hero until I shed my white coat and left the clinical world. I felt a catch in my throat at giving up the identity of being a doctor. Truthfully, I enjoyed feeling superhuman sometimes. It was an adjustment to let that image go.
But when has the notion of physician as superhuman gone too far? I thought about this question often during my residency training. Working continuously for 24 or even 30 hours (I trained before the current duty hour restrictions) seemed like a lot to ask of a human body.
I was faced with this question again recently when a physician courageously spoke out about a cause of burnout that I hadn’t considered sufficiently before: the expectation of virtually constant availability.