What causes physician burnout, and how can it be prevented?

Physician burnout is very real and a troubling problem for healthcare, with studies finding that at least 50 percent of U.S. physicians struggle with burnout. An increased workload and less time to see patients are big contributors, but clerical burden is playing an increasing role in professional dissatisfaction.

Most clinicians feel that the administrative tasks required of them don’t add value to patient care and are unrelated to the reasons they chose their professions. As mental health experts have noted, the disconnect between one’s calling and one’s daily work contributes to distress, and can lead to alienation, isolation, depersonalization, cynicism, emotional exhaustion and burnout.

The pressure is also felt by nurses, with concerns that they are spending more time entering information into electronic health records (EHRs). Indeed, aside from improving medication safety, where careful documentation is vital, nurses and other clinicians report dissatisfaction with the design and cumbersome processes of electronic documentation.

As a result, clinicians lack control over their workday, resulting in a loss of collegiality while working in isolation, as well as interference with the patient-clinician relationship as a computer screen creates a physical and psychological barrier between them. EHRs have spawned a new exercise for doctors known colloquially as “Pajama Time,” with mandated documentation being carried out after hours simply because clinicians don’t have time for it in their busy working day.

The consequences of the additional burdens faced by clinicians are severe, with more and more of them battling mental illness, which in turn has serious consequences for patient well-being, since patient safety depends on clinician well-being and fulfillment.

Industry disconnect

The industry must find a way to balance the well-being of clinicians with the requirement to use systems, including EHRs, for the purpose of medical coding and subsequent reimbursement and payment for those services.

Part of the problem with EHRs can be attributed to the fact that many were implemented rapidly without giving clinicians and organizations the time they needed to redesign workflows or insist on design changes in EHR systems that would better support clinical care.

Another problem with the current crop of EHRs is that they are designed to work within the four walls of a given healthcare organization, whether in inpatient or outpatient settings. However, only 2 percent of patient activities take place in these settings, particularly for chronic diseases, which account for the majority of encounters (those taking place in the home and beyond). As a result, clinicians interacting with patients outside of a doctor’s office have to go back and enter information from these encounters. That’s not only time-consuming, it also means clinicians frequently fail to input such key information as findings, progress, outcomes and so on, which results in incomplete stories, errors and the potential for improper treatments.

Recent studies further indicate that, in a variety of settings, clinicians routinely use copy-and-paste or copy-forward and that most clinical notes are the result of copied or imported text. The result is that the patient’s story gets lost in a fog of repetitive and redundant information.

Putting the clinician into the picture

Given the scale of investment in EHRs, the question healthcare organizations must grapple with is how to respond to the problems clinicians currently face? Rather than replace EHRs, it’s possible to layer-in solutions or applications that will free clinicians from their clerical burdens and focus on helping them to do their job — which is to engage with patients. These systems of engagement sit above the EHR, supported by a unifying platform, and feed their output into the EHR.

And since healthcare today also takes place outside of traditional settings — telehealth, community-based care, etc. — these systems of engagement are most effective if they allow whatever user interaction is most appropriate, such as keyboard-free computers, mobile and remotely accessible environments.

To make the patient a central member of this digital environment and move toward a truly patient-centered care approach, there needs to be a fundamental design shift in how healthcare organizations and clinicians leverage technology and how information flows between the patient and the clinician and vice versa.

If the patient becomes a trusted member of clinical documentation, and if the caregiver focuses — through those digital systems of engagement — on the real clinical needs of patients, it will become possible to free up healthcare professionals from their clerical burdens, helping to prevent further burnout.


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