Physician Burnout and The Patient Experience: Are We Overlooking a Crucial Element?

Herdley O. Paolini, PhD; Kathleen C. Gibney, PhD; Richard J. Bogue, PhD


October 31, 2014

In This Article


We recently conducted a small-scale, uncontrolled pilot study postulating a causal relationship between a measure of improved physician well-being and improved HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores revealed the possibility that the patient experience, at least as it relates to physician communication, may be intrinsically tied to the physician experience.

Is it possible for physicians to deliver personalized, relational, compassionate care while they are dissatisfied, burned out, and disengaged? Is it possible to achieve the results that are needed as they relate to the physician-patient relationship by deploying a quick script or course on the "right words to say, eye contact, and sitting down with the patient," regardless of the physician's state of mind or health?

The results of cognitive attempts, quick fixes, and the teaching of new skills have so far not been encouraging. We believe that it is because we try to train a physician in technique when what we desire is a compassionate presence. For that, we need physicians who are experiencing their own wellness, who can access the language of caring, and who will find a way to be resilient in maintaining their health, wellness, and satisfaction in the midst of the overwhelming ever-changing business of medicine.

Although the results of this pilot study are insufficient to draw definitive conclusions, one observed phenomenon was a jump in the institution's HCAHPS score from the 2nd to the 41st percentile. But the real finding is the potential value of additional research. The issue is important to physicians and hospital leadership alike, because it focuses on what may be the missing element in today's efforts to transform healthcare.

Physician Health and Wellness

It is common knowledge that the patient experience, marked most noticeably by HCAHPS scores, is at the forefront of healthcare institution priorities. Much is riding on its success: reimbursement for both hospitals and physicians, and the loyalty of patients, which in turn can assure future viability in a competitive market. In the past 30 years the Patient Experience Movement has undergone tremendous change, driven first by the need of hospitals and physicians to generate volume; second by the Joint Commission, which outlined the need to improve strategies for both quality and service processes; driven now by HCAHPS and the 2010 Affordable Care Act's use of patient experience data in the calculation of reimbursement.

One of the areas measured by the HCAHPS standardized survey is physician communication with patients, which is scored on a combination of answers to three questions:

During this hospital stay,

How often did doctors treat you with courtesy and respect?

How often did doctors listen carefully to you?

How often did doctors explain things in a way you could understand?

These three questions are related to an underlying assumption based on relational values, such as an ability to be present, attentive, and caring. Physicians struggle with the consumer-oriented, commercial-world model of delivering care and with data collection that focuses on patient satisfaction without understanding or incorporating the complexities of patient care. Some have argued that patient satisfaction is a misguided goal. It can be said that this is not the entertainment or hospitality industry. Some physicians hold that it is demeaning to healthcare professionals to empower patients to grade them without first engaging patients in understanding and participating in the process of healing. Such arguments about data collection on patient satisfaction are beyond the scope of this article. HCAHPS is here to stay until such a time when a more holistic and integrated view of the patient experience can be understood and developed.

Physician training, combined with the current environment of practice, is not yielding the holistic outcome that physicians, patients, and the healthcare community desire. Medical training and practice focused on technique rather than identity formation has consistently failed to integrate emotions with cognition. Focusing strictly on technique has devalued personal integration, wellness, and the individual physician's judgment to some extent, characteristics at the core of medical practice. In addition, constant change, a focus on volume, procedures, and litigation have left physicians running on a treadmill, feeling hopeless to effect positive change. Despite the fact that various studies have shown that 40% to 60% of US physicians are experiencing symptoms of burnout—the hallmark of which is emotional exhaustion, low sense of accomplishment, and detachment—physician health and wellness has received little attention. Moreover, current patient-experience improvement programs fail to connect the dots between the patient experience and the emotional state of mind of the care provider.


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