Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments while they rush through patient encounters.
During a lunch break at a recent health care conference, Dr. Michaels*, an internist, shared her story. Dr. Michaels worked for a major academic hospital, where she was required to see 14-16 patients a day.
When she didn’t meet her productivity requirements, her salary decreased by 7 percent. For two consecutive years, her wages drop by 14 percent, forcing her to leave the practice and feeling depleted and unappreciated. As a result, she gained 100 pounds and developed hypertension due to stress. According to Dr. Michaels, the hospital made no effort to retain her, despite her 27 years of dedicated service, further leaving her feeling diminished.
Dr. Simonson* was seated on my right; he was just two years out of his family medicine residency and working in a concierge practice. The first words out of his mouth were, “I love my job!” He noted that the most important thing for him was the “human connection and the ability to spend more time with patients.” Concierge practices have been springing up all over the country, and they offer patients more direct care for either an annual fee or a monthly membership fee. Doctors tend to see fewer patients per day and are well compensated.
“I am so thrilled to hear you love your job.”
“Yes, thank you for saying that.”
“There are too many unhappy doctors these days,” I added.
He nodded in agreement.
“In my experience as a patient and a physician, doctors feel rushed, and they don’t do complete physical exams or take much of a history. When I was in my medical training, we were taught to do a complete physical exam from head to toe on every patient, with a thorough history and review of systems.”
“Oh, we don’t do that anymore; it is all about risk management and assessing for safety. We don’t do complete physical exams. That’s old-school,” he chuckled.
Dr. Simonson told me he conducted an initial history and physical assessments in 40 minutes. In my mind, that was not enough time. If you don’t examine your patient’s entire body, you could miss something significant, like enlarged lymph nodes or a melanoma, I thought to myself.
Dr. Pamela Wible, MD, a physician advocate, and speaker, who has made it her mission to inspire doctors to start what she calls “micro-practices.”
A micro-practice can be established with minimal overhead, allowing doctors to see fewer patients and spend more time with them. She encourages doctors who have been on the verge of leaving medicine, who are suicidal or depressed, to work for themselves and exit the big-box clinics and hospitals.
She has helped hundreds of doctors bring creativity and innovation to their work by encouraging them to be the change they want to see in medicine. In Dr. Wible’s vision, the relationship is between the doctor and the patient is sacred and should be nurtured. In micro-practices, there is no need for additional staff.
I often wonder why we need so many ancillary staff in doctor’s offices? There are nurse practitioners (NP) and physician’s assistants (PA) who practically function as doctors, with fewer years of training. It has been my experience as a patient, the NPs and PAs do the preliminary work for the doctors, take the initial history and do the physical exams, only to have the doctor or surgeon come into the room and nod he or she agrees. As a result, the doctor spends less time with the patient. When scribes are present to assist the physician with documentation, patients may not be as forthcoming with a non-clinician in the room, and it may impede the doctor-patient relationship.
Daniele Ofri, MD, author of What Doctors Feel: How Emotions Affect the Practice of Medicine, noted the rate of severe diabetic complications was 40 percent lower in patients whose doctors scored high on empathy. She stated a factor such as empathy, had similar benefits to those seen with intensive medical therapy for diabetes.” Doctors aren’t compensated for listening to their patients. If they spend too much time with patients, they are seen as inefficient or slow. Medicine today has missed the power of empathy in healing.
When I go to the physician, I, too, have noticed that there is minimal touch by the doctor. Physical exams are sometimes superficial. Hands are frequently gloved, and instruments are often a barrier between the physician and patient. The invention of the stethoscope created distance between the physician and patient. Now with the enormous dependence on technology and more of a reliance on imaging and laboratory data, touch and physical exams have lessened and at times, are nonexistent.
What I love about being a physician is putting the patient’s story together piece by piece. I consider myself a detective of sorts. The joy in medicine and the benefits of being a physician are lost if we are only medicating and chasing symptoms without looking at cause and prevention.
If we as physicians feel that we are just going through the motions every day, checking boxes, meeting productivity requirements, checking labs, we bound to fall short of our calling with diminished empathy for the people who need us most, our patients. It is the human connection that brings us joy in our work and lessens the burden of burnout. Let’s all find a way to be the change we would like to see.
* The names of the physicians were changed to protect their identity.
A version of this post first appeared on my kevinmd.com blog.