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    The no. 1 disease at your office isn’t clinical

    There’s a growing and critical health epidemic running rampant in doctors’ offices today that requires triage, treatment and a dramatic change in how primary care physicians practice medicine.

    The condition is physician burnout and the symptoms are severe.

    According to a recent survey of U.S. primary care doctors conducted by Ipsos and MDVIP, more than half said they’ve seriously considered changing their work situation due to professional stress, and 40 percent have even contemplated quitting medicine. Three out of four report not getting enough sleep or exercise, while more than half are overweight or obese. Eighty-three percent say the overall demands of the medical profession not only impact their ability to spend as much time with patients as they’d like, but also significantly impact their personal life.

    Other studies suggest the problem isn’t getting better; in fact, it may be getting worse. According to a Mayo Clinic study in 2014, 54 percent of U.S. physicians surveyed reported at least one symptom of burnout, up from 45.5 percent in 2011.

    This is not the way docs fresh out of med school dream of practicing and is a far cry from the fictional lives of their TV heroes—a la Dr. Marcus Welby, Dr. Mark Greene, Dr. Gregory House—who have the luxury of time to get to know and treat their patients, research anomalies and seemingly do no paperwork. Sure, these are fictional characters, but the further we drift from this ideal, the more concerning the problem of burnout—and its impact on patients. Physician burnout is linked with negative consequences, such as delayed or even missed diagnoses and over-medicating patients.

    Yet even the most burned-out physician isn't without hope for change. By understanding the causes and effects of burnout, including its impact on patients, physicians can make changes that will leave them feeling less stressed, and more fulfilled. And by putting new solutions into practice, physicians can stop burnout from escalating and improve their own health.

    UNDERSTANDING BURNOUT’S BURN

    While there are many factors that influence burnout, one of the most common complaints among physicians is that they’re working longer hours. They're often spending so much time on paperwork that they don’t have enough time to fulfill their true calling—caring for patients.

    When doctors have too many patients and not enough hours in the day to see them, the result is rushed appointments. And more than half of physicians (54 percent) admit they often end up writing prescriptions or referring patients to specialists because of time constraints. This figure is alarming when we consider that nearly one in three antibiotics prescribed is unnecessary.

    What physicians need is more time—time to probe deeper into a patient’s concerns, time to consider the total health of patients with chronic conditions and time to encourage (or engage patients in) preventive strategies. However, at the end of the day, physicians sometimes leave the office feeling mentally overwhelmed, asking themselves whether the 10-minute appointment shortchanged their patients: Did I miss anything? Did I order the right tests?

    Next: Helping doctors

    Andrea Klemes, DO, FACE
    Dr. Andrea Klemes was in private practice for 10 years as a board-certified internist and endocrinologist in Tallahassee, Florida. She ...

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    • [email protected]
      There are no easy answers to physician burnout Here is one of many avenues that could help High Touch A Course in Compassion Healthcare is broken and doctors are burning out. That is the current mantra. Healthcare has gotten too expensive and impersonal, and there is inconsistent access to that care. Doctors are increasingly stressed and do not seem as engaged. Patients complain that their doctors are too busy and no longer listen. They ask, “Who will take care of me as a person and not just as a bunch of x-rays and lab test results?” I trust my doctor, but why does she seem so distracted and disengaged.” With all the technological advances of the last several decades, with genomics and PET scans, MRIs and super-subspecialists for every conceivable body part, what in the world is happening to the very doctors who care for us? We have all this “High Tech,” but, where is the “High Touch?” Is being a physician no longer a calling? Has it become just another job? Have patients become commodities? Why has doctoring gone astray? Gaps The American system of medicine has become organized largely as a disease-management system, and not as a health-care system, with diagnoses and treatments now reduced to an impersonal set of numerical codes. The concept of “caring” is no longer central to a discussion of “health care.” Patients are being viewed by their health care providers more as the sum of their diagnostic testing, or as the "I-patient," to use the term coined by Abraham Verghese M.D. of Stanford University, which is to say, the "virtual" patient, seen by the physician more through the lens of that physician’s pda, laptop or computer screen, and not as the real, live, hurting individual in front of them. Of course, this is an oversimplification. There are legions of dedicated doctors who are serving an ever larger and aging population, and who do so with empathy. But we as a society have indeed reached a watershed moment, a saturation point on many fronts. We now live ever more hectic and hurried lives, with hardly a moment to stop and reflect. With increasing demands on our time and resources, we have become more anxious, are getting less sleep, and are making poorer dietary choices. The cumulative effect of this leads to illness. However, when we get sick, we still want help, and we have come to expect that help to be prompt and caring. Yet, even when we do find that help, it seems to have become curiously robotic and disengaged. It is crucial for the health care profession – now a health care system, comprised of collaborative teams of physicians, nurses, PAs, social workers, ethicists, and even economists – to remain focused, engaged, vibrant, and committed to caring. We cannot have it any other way. We cannot be a healthy society, with healthy citizens contributing to the success and happiness of that society, without an engaged health care team. We need to (re)-train physicians for a lifetime of caring, so that they continually demonstrate empathy in their work, and so that they themselves remain energized and happy in their careers, as this will improve patient outcomes over time. Physicians cannot heal without caring, and they cannot care without first being informed by a core set of ideals that will carry through their training and into their professional careers. Medical schools are set up to train physicians, and at many of them, there is already an awareness of these problems which I have outlined, and some initiatives are in place. But the system, engrained and with its own cultures and rituals and focused on disease management, has lost sight of its ideals, the ideals embodied in the Hippocratic Oath. Solutions: Frameworks in Medical Humanities We must re-embed a pathway of caring in our health care providers and transfer a lifelong set of skills that will inform them throughout their careers, certainly in the physicians who still lead the health care team. What is needed is an overarching and cohesive rubric, which I have entitled The Course in Compassion: A Curriculum of Caring (The Course). These skills can be identified, quantified and measured, and will populate The Course. The Course will be divided into modules, and taught using an accepted paradigm in most medical schools, the Problem-Based Learning (PBL) format. Six core modules, which are termed “Frameworks in Medical Humanities,” would be taught over the four years of medical school in weekly two-hour sessions: Sensory experience Motor task Dance and Movement Motion Research Music Appreciation Rhythm/Melody-Making Narrative & Reflective writing Diary-Keeping Mindfulness and Spirituality Yoga/Meditation Art & Aesthetic Appreciation Drawing/Sketching Empathy Training & Acting Care-Giving Stakeholders Patients, physicians and physicians-in-training (medical students and house officers), medical school administrators, curriculum designers, The Association of American Medical Colleges, state licensing boards, and insurance companies – each of these entities is a stakeholder with a say in physician education. Adopting The Course will require hours of time to teach its principles, hours that will have to be taken in part from existing core disciplines as anatomy, biochemistry, pathology, physiology and microbiology, as well as from time already assigned to the medical students for hospital wards and outpatient clinics. Conversations will need to occur at many levels to allow stakeholders to “buy-in” to The Course as a foundational aspect of medical education. However, The Course does not have to be built “from scratch.” There exist a number of programs which have pilot projects aligned with my vision and ideas. A number of medical schools, (Harvard, Yale, Weill Cornell, Johns Hopkins, Stanford, UCSF, and Columbia, inter alia), offer courses which champion aspects of The Course. These existing initiatives are already testing the “proof of principle” of The Course. They are virtually all elective (that is, they are not required to graduate), but they exist. Therefore, it is not necessary to “reinvent the wheel” to populate the syllabus of The Course. Rather, The Course would be populated with “best practices” from existing efforts in addition to new initiatives I would add that have not yet been created or tested. As Harvard Business School Professor Rosabeth Moss Kanter has written, change is often a result of “Big Vision and Small Steps.” The Big Vision is creating and curating The Course in Compassion: A Curriculum of Caring (The Course). The small, essential and crucial steps are to pilot a series of medical humanities courses in all six modules, and, utilizing longitudinal data analysis, create metrics to measure patient outcomes and satisfaction over time, and physician satisfaction through their careers. Impact “It is far more important to know what person the disease has than what disease the person has.” Hippocrates Medical humanism is a core set of ideals that should be taught from college through medical school, internship and residency, and that should continue to inform a physician through their career. Medical humanism serves as a beacon and lodestone for how physicians listen, respond and care for their patients, as well as providing a road map for the well-being of a physician’s own mind and body over the course of their professional lives. The Course in Compassion will be a foundational paradigm around which physicians can be better engaged, and more motivated and passionate about providing care. Patients will achieve better outcomes, and physicians and their healthcare teams will enjoy longer and more fulfilling careers. This is an initiative which can no longer be fragmented, ad hoc and elective. The Course must become the epicenter of medical education and professional practice. © Vincent P. de Luise MD FACS
    • UBM User
      This course sounds wonderful, but you should probably write your own OpEd where people may actually read it. I surely hope that your course includes a strong dose of SELF compassion, which is so difficult to maintain in the setting of all that was described in the original article. I would also hope you realistically include sections on dealing with litigation stress, which is going to be all the more common with physicians unable to establish firm relationships with patients due to time constraints despite the humanism that can be applied in an RVU. And dealing with depression, an extremely mental illness which is somehow associated with the occupational stress syndrome of burnout but is NOT a direct result of burnout in non-predisposed individuals. I deal with both these conditions in physicians, whether or not they are also burned out. See MDMentordotcom and PhysicianSuicidedotcom. Louise B. Andrew MD JD FIFEM

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