We expect doctors to provide state of the art care and help us get better from whatever ails us. By nature, patients are self-centered and believe that doctors should only be concerned about our problems. Of course, that’s their job but we often overlook what it’s like to practice medicine in today’s healthcare delivery climate. So, should we make an effort to openly acknowledge the increasing time pressures and demands facing those who have our health and well-being in their hands? With reports of significant physician burnout, do they need our support and understanding? The answer is yes and yes.
In “Clarifying the Language of Clinician Distress” (Journal of the American Medical Association, January 31, 2020), authors Wendy Dean, MD, Simon Talbot, MD and Arthur Caplan, PhD explain issues that contribute to physician distress. The list includes making difficult clinical decisions, reduction of quality time with patients and the financial framework of medical care. Although there have been initiatives to help clinicians improve self-care and manage stress, there have been no successful remedies to address the systemic causes of burnout.
In a related commentary on WBUR (Boston) Dr. Dean, one of the articles’ authors, delves deeper into this problem by identifying moral distress and moral injury as the underlying factors that result in burnout. She shares a personal experience regarding the disengaged care her husband (also a physician) received at their local hospital, which almost led to his death. She notes, “The system has bound the physicians so tightly with scheduling, data and metrics, policies and punishments, that they too could hardly breathe… They stopped fighting back because it was futile. They were beaten and stopped empathizing, became disengaged.”
If we don’t stop to acknowledge that clinicians are confronting increasing time pressures and burdensome record keeping, we are ignoring the other half of the doctor-patient relationship. It is not a leap to conclude, as Dr. Dean points out, that burnout can also impact the care we receive. With this issue in mind, you probably wouldn’t be surprised to learn that we chose the topic of “Building Physician’s Trust with the Healthcare System” for a recent Doctors Conversation Hour, a program hosted by the Center for Communication in Medicine. From the discussion that evening it was quite apparent that doctors are very concerned about how increasing demands impact effective patient care, which is also a key source of their job satisfaction. It’s a complex problem with many competing stakeholders and finding a solution remains a challenge.
This topic also takes me back 20 years. During my tenure as a medical humanist at the cancer center in Bennington I would often hear patients tell me –“doctors have a stressful job.” I would encourage them to tell their doctors what they said to me. Now, you can say that am I proposing that patients openly express empathy toward doctors about what is being imposed on them by the healthcare system. It may appear that it’s a lot to ask of seriously ill patients and their loved ones but we need to let one another know we’re in this together. Our lives may depend on it.
The doctor/patient (and patient’s family) relationship is a unique relationship which works best when all parties feel that they all have the best interest of the patient as a first priority. This is usually one of the most stressful situations and all of us benefit from knowing everyone around the table recognizes the stresses and has confidence in the motivation to do what is best for the patient. We can’t assume understanding of these stresses we need to give voice to them. It is challenging to do this in the tight time frame that many institutions place on the physicians time with a patient. Still it is important to give reassuring words as often as possible.
A thoughtful and sensitive piece that provides needed balance in scenarios that are often difficult for everyone. Dr. Paul Gross, editor of PULSE: VOICES FROM THE HEART OF MEDICINE, an excellent online weekly out of Montefiore Hospital in the Bronx, NYC, visited my Literature & Medicine class at Rutgers today and we all got a glimpse of frustrations, regrets, fears, and other inevitable emotions from the doctor’s side.
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