COMMENTARY

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

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

Disclosures

October 31, 2014

In This Article

Discussion

Patient experience is the current holy grail in healthcare. What began as patient advocacy and risk-reduction efforts is now a full-scale customer service deployment with articulated goals, drilled messages, and incentive programs. Whether guided by the right motives—to personalize delivery of care and engage patients in the healing process—or to generate volume and revenue in a highly competitive market, care that is delivered in a compassionate, personal, and excellent way should always be the ultimate goal. But the difficulties in achieving such a goal point to a deeper, more complex issue, one that will take more than cue cards with the right phrases, shaming score card strategies, or coaching provided by those with background in the hospitality industry.

We cannot safely point to the exact time and place when medicine became a full-scale business and hospitals became volume-driven financial institutions. There was a time when physicians had personal—usually long-term—relationships with their patients. They did not consciously choose to end that, but they participated either by omission or commission in the changes that fundamentally led to the hamster-wheel medicine way of practicing medicine. Physicians and hospitals are too engaged in the profit opportunities, not entirely conscious of the need to hold the tension between the calling of medicine and the business of delivering care in a transparent and real way, or the need to attend to the human limits involved.

In addition, the scientific and technological evolution, with its myriad possibilities as well as diversions, keeps introducing constant change—more and more, faster and faster. We have not yet met a physician who, after sacrificing years of training, sweat, and tears, wants to provide substandard care or be harmful to patients. In fact, it continues to be the opposite, per every physician who states, "I just want to do the best I can for my patients." It is worth noting that this extra effort often increases physicians' risk for burnout, secondary trauma, and poor well-being. Yet, most are despondent in regard to how to maintain their souls and their love for medicine in an environment that is toxic and not conducive to bringing out the best in themselves or their patients.

What is needed in the delivery of care is transformation—from consumers and providers and customer-centered care, to healers and patients mutually engaged in the creation of a culture of healing, where the healing relationship is at the center. This would require whole physicians, nurses, and caregivers. Healers in need of healing cannot heal, and those who lack self-compassion have difficulty accessing compassion toward others. In addition, it would require hospital administrators to work together with physicians to design an environment of practice that sustains the humanity of all involved. The level of physician and staff burnout, disengagement, and frustration should lead us to pay attention to the lack of readiness to engage meaningfully in the healing process. The healthcare culture does not always support healing. Broken delivery systems not only increase the very costs they are supposed to contain but also needlessly frustrate all involved. The training of physicians and their culture of practice often do not support their emotional and relational development, which is crucial in a healing relationship.

This study is a small attempt at honoring the total experience of physicians in this current environment of medical practice, and providing them with tools to help them navigate their presence to their benefit and that of their patients. More research is needed into the training and environment that will best create and sustain the health and holistic development of physicians toward the ultimate goal of personal, effective, and compassionate care. A holistic CME retreat format may be a time-efficient starting point to help initiate the needed change. The study also points to the need for more comprehensive, ongoing support of physician health and well-being. We believe that this, in turn, will have significant implications for achieving quality and healing relationships.

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