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President’s Message

 

S  TTmmer 2015

Tom Kintanar, MD  FWMS President

President’s Message: Greetings

 

 

Greetings to all of our hard- working membership! At the time of this writing, I hope you are healthy and of great mental and emotional balance.

The subject of my message for this quarter is physician overwork and burn out. The last dialogue was a tribute to not only the mentors that have shaped my career but all mentors who have shaped the careers of all of us serving our community. This message entails a dialogue of great concern to anyone who serve patients day in and day out. This affects every specialty and subspecialty in our medical community.

The dawn of technology has advanced our knowledge base exponentially. But with that comes a burden of accuracy that has been placed on our physician community that has been unparalleled.

I will start with my story. My former independent Family Medicine group, Associated Family Medical Consultants, decided to integrate an electronic medical record system (EMRs) into our daily practice. We chose an EMRs which was very facile and afforded us the opportunity to enter notes and serve a reasonable number of patients. A recent New England Journal of Medicine (NEJM) editorial noted that the newest medical students are now millennials. These brilliant new colleagues in training are very adept at a numeric and technological education. This is in great contradistinction to my baseline skill set in which I found it difficult to adapt to our EMRs. For two years I acclimatized to the system by staying awake well into the wee hours of the morning. (My usual bedtime was 12:30 to 1:15 a.m.) I was eventually able to assimilate the system but was serving patients at a level which was far below the numbers that I served previously. The numbers were truly not the issue, however. The patients that I had served for years were quite surprised when their wait time for an appointment went from approximately five days to 2 to  3 weeks out. It was extremely frustrating as I struggled to maintain a caring relationship with my patients, enter data appropriately, and be cogent enough to come up  with a diagnostic plan while trying to get through my day. At the end of every day, I brought my laptop home in order to finish my “homework” which as described earlier would go into the early morning hours.

As the changing course of medical care evolved, we eventually sold our practice and became members of Lutheran Medical Group. As expected, practice cultures changed and a new EMRs was implemented. Once again, we were all tasked with learning a “new language” of EMRs. This unfortunately took me back to the “drawing board”. Once again I brought my “homework” home with me working into the early morning hours. It was very evident to my staff and kind management team that I was struggling greatly. I subsequently was a afforded a scribe. The scribe, that some of my more technologically savvy colleagues may feel is a luxury, was personally a career and life saving measure. She was a true gift.

Like all of you who serve patients in our community, hard work is not an issue. Patient care is not a “job”, it is a passion and a true calling! The “fly in the Vaseline” is when we are tasked with becoming data collectors and technicians. There is no joy in operating a computer while trying to keep eye contact with your patient and expressing your true concern regarding their medical and emotional issues.

My story is just the tip of the iceberg. The medical literature at this point is ripe in articles regarding burn out and even suicides in our profession. Dr. David Rosenthal’s Perspective in the November 2016 NEJM states that the literature reflects residents and students now spend 40 to 50% of their day in front of a computer screen filling out documentation, reviewing charts, and placing orders. The other part of the day is spent coordinating care with pharmacists, specialists, nutritionists, family case workers, etc. There is very little time spent with the patient. The end result is a greater amount of dissatisfaction because of the time required to transcribe and translate information into a computer, which in my case was a great deal less satisfying in more meaningless indifference to actual contact with our patients and patient care. This in turn has led to burn out and a higher preponderance of depression not only among our medical students and residents, but our colleagues in the profession in  general.

Our daily workplace environment has evolved drastically over the past several years due to:

  • the implementation of EMRs
  • trending from private practice to becoming employees
  • the movement towards a team-based vs physician visit based care with the rising presence of our mid-level colleagues
  • continually evolving credentialing requirements
  • increased regulatory and administrative duties
  • insurance product refinement i.e. preauthorizations and panel size changes.

All of these challenges contribute to a sense of loss of our autonomy and our ability to enhance the most important component of being a physician: bond, relate, and care for our patients.

There are the innovators in medicine who look for ways to enhance the physician patient relationship. They also have re-engineered practice patterns to use the tools that I have earlier stated to make a more well-organized and even more user-friendly model in providing efficient and technologically savvy patient care. If these colleagues’  beta projects are successful, we may find an effective way to circumvent the higher rate of depression and burn out that exists currently.

Do we have all the answers? To say that the work is in progress is an understatement. In reading several articles in order to find out about the magnitude of this problem, it is evident that my scenario was one of thousands. This is a very complex and difficult matter to tackle. It will take dialogue among colleagues and support from our national organizations in order to provide structure and guidance. The professional environment, in which  we now experience so many stresses, makes it a very challenging time. There are many colleagues that have suffered burn out, depression, substance abuse, and even thoughts of suicide in silence. Because we are in a very privileged profession, I believe we have the tools to overcome and master this challenge. But it will take a lot of dialogue, persistence, hard work, and God’s blessings to keep our medical flame from ever coming close to burning out.