Physician Loneliness: Just Me and My EHR

Brandon Cohen

Disclosures

March 14, 2019

A recent article by Dr Gregory A. Hood examined the issue of isolation among physicians. In particular, Hood was concerned about professional isolation and posited that modern doctors found less support and friendship among colleagues than had been the case for previous generations. He also wondered whether contemporary modes of learning and practicing medicine contributed to this increased loneliness.

This led to lively, and often anguished, discussion in the comments.

Many felt that the article was spot-on and shared their own pain. An internist kicked things off:

The joy of medicine is dying, and the art of medicine is also a thing of the past... Medical school was challenging, but it could be fun. The two residencies that I chose to do were even more challenging, but the love of learning and growing as a physician made it a magnificent time... Whenever asked if I would choose medicine again, I never hesitated to say "absolutely" until three years ago. If I knew then what medicine was going to be like once I hit my 50s, I never would have chosen this.

A urologist also recalled better days:

The hospital used to be a place to interact: I would call a referring person with my consultation recommendations and discuss the patient's care with nursing. Everybody benefits... Now, many specialists wouldn't recognize their referring physicians and vice versa if they passed them on the street.

An emergency physician agreed:

When I was in medical school we studied in groups, in clinical we all hung out together and talked about the patients on our services and compared the way our attendings treated the same diagnoses so we could learn from each other... Nowadays there are less and less of these gatherings... We used to have medical society meetings, hospital staff meetings and general monthly get-togethers... It is a shame, we all could benefit from the shared knowledge of our peers.

A psychiatrist took the baton from there:

I miss medical school and residency. I never, ever see the other psychiatrist I work with. In residency, I would have time to stop by my colleagues' offices and talk or just vent. Now it is just a race to get to leave the office at a reasonable time.

Many colleagues looked to pinpoint the source of the problem. A psychiatrist spoke for many:

The emphasis on salaried hospitalists in academic centers, on speedy discharge, financial focus on discharge planning as well as the harried comportment of today's paperwork-skewered physician has greatly contributed to this [increased isolation].

An infectious disease specialist continued in this vein:

I love spending time with my patients in my outpatient practice [but then] I have to sit in front of a computer screen, often after hours and on Sundays to catch up. Takes time away from families, friends, even socializing with staff in the office. I didn't sign up for this when I went to school.

An endocrinologist underlined what was lost when interaction among doctors was curtailed:

I'm a better doctor and a more fulfilled human being when I can communicate with my physician colleagues in different specialties about a case.

But some felt that rigor and loneliness were inevitable—simply part of the territory. A rehabilitation specialist wrote:

We knew [about isolation] when we choose this path. No, medical school was not fun. I spent grueling hours alone studying and this continues into residency where everybody is too busy to even look at you.

A family physician argued that doctors created this problem themselves:

12 years as solo PCP, followed by another 35 as psychiatrist and clinical leadership roles have convinced me that it's not "the system." We isolate ourselves. On a daily basis, I hear physicians resist team-based care and refer to nonphysicians as their inferiors. Not many quality relationships ever result from that attitude. Once we all give up our supremacy, we may not be as lonely.

And an emergency doc wondered whether all this wasn't just standard nostalgia:

When I was in my 3rd year of med school at Stanford, 1971, while rounding on the internal med unit... our attending gathered us together in the hallway to say, "Fellas, medicine is just not as fun as it used to be."

An internist believed that the problem was real but put the blame on physicians:

I hate to say it, but I think we allowed this to happen inadvertently under our own eyes. While we were working hard studying and trying to provide excellent care, CEOs slowly took away autonomy without any pushback.

Another physician suggested that there was perhaps too much defeatism in many of the comments:

You have to make time for those interactions we are all lamenting are gone. There are 168 hours in a week. Use them. A few years ago my wife told me some of my colleagues mentioned to her that I was aloof and withdrawn. I thought I was being efficient! I changed the pattern and now have better days because of it. What it does take is effort. Your day will get longer if you take 20 min at lunch to talk to colleagues. So what, the day is a little longer. Medicine is not an hourly wage job, it's a vocation. Your day will be longer but your career (and life) will be more rewarding.

The last word goes to a primary care physician who went back 60 years for a dose of perspective:

I started practicing in 1959... I recently began working in a new town and the office gave me a list of consultants that they had been using. I went to visit them, and they were surprised that I had come. One said nobody had ever done that before. It is so much more lonely now than when I started. I remember the coffee room we used to hang out in and compare notes and get to know each other. I am now in a situation where I can spend as much time as I need to with a patient and I love it.

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