COMMENTARY

What's the Next Step Against Physician Burnout?

Alok S. Patel, MD; Tait D. Shanafelt, MD

Disclosures

May 22, 2019

Alok S. Patel, MD: Hi, everyone. I'm Dr Alok Patel. It's an honor to talk to Dr Tait Shanafelt from Stanford University. We're going to talk about something that I think all physicians and even pre-med students know about, and that's burnout.

Dr Shanafelt, you're a leading expert on this. What is the crux? We know it's a problem, but what's the next step?

Tait D. Shanafelt, MD: We need to begin addressing burnout at the system and organizational level. Fundamentally, we know that it is not a problem of personal resilience or about weak workers. It's about a broken system and environment that make it difficult for physicians to do the work that needs to be done. Physicians recognize what their patients need and they do all in their power to try to bring it to them, but oftentimes, they feel the system or the environment is actually working against them in providing the care patients need.

We are now aware of the problem. Some organizations are at the table still with personal resilience offerings. Increasingly, senior leaders know that this is really about our workflows, the practice environment, and the support we must provide physicians to make it much simpler for them to care for patients. That's really the next step.

Patel: As a physician who has experienced burnout, I look at what people write online, and I hear things like yoga, mindfulness, ice cream social, and pizza day. I do respect the gesture and I think it's important to have those personal tools to take a step aside.

Can you give us an example of something you've seen an organization do that you believe is a step forward?

Shanafelt: Obviously, there is nothing wrong with those ideas.

Patel: There is nothing wrong at all. To the yogis on social media, don't come after me! It is useful, but we're talking organization changes right now.

Shanafelt: Right. None of those ideas on social media are going to make a meaningful dent in this problem. I think it begins with leadership. That includes not only recognizing the problem and prioritizing it, but also the way that organizational leaders (be they physicians or administrative leaders) actually engage physicians in the conversations about what is not working with EHRs, workflows, and staffing, and what levels of support they have. All of those things are critical.

I think we often become fixated on the EHR. I refer to it as the visible dragon because so much of our workflow goes through the EHR. There's so much room for improvement there.

Our EHR notes are 80% longer than the same note for a patient receiving excellent care in other modern countries!

But obviously, there are many other things that you think about in your daily workflows. How is triage done? How are patients scheduled? How efficiently are they roomed? How many rooms are you working out of? How are orders entered? How is documentation completed?

What's the consistency of the team that you work with, the way you understand each other, and how you work that makes your life more efficient? How does your organization interpret policies and regulations that create excess documentation for you?

Patel: The documentation is horrific.

Shanafelt: It's a major challenge. Obviously, I think we all took note last summer when folks looked at the length of clinical notes for a given health condition seen by a certain specialist in the United States versus the same note in Western Europe. Our notes are 80% longer than the same note for a patient receiving excellent care in other modern countries!

It really isn't about medical care. That difference is about regulation. It's about what our payers require. It's about the litigious nature of our practice environment, where we have to add documentation to prevent malpractice suits. There are many factors that feed on that, but at the end of the day, you're completing that unnecessary documentation for those reasons.

Tips for Preventing Burnout

Patel: Can you give our future doctors of America and our audience one memorable tip to prevent their own burnout or to get involved?

Shanafelt: What can we do for ourselves? I think that we need to continue to emphasize that this is a system issue and it's not about personal resilience. That said, we're not victims and we can be the solution to this problem.

We, as physicians, tend to be very hyper-self-critical. We're more compassionate and supportive of our peers than we are with ourselves.

We need to engage with our leaders and administrators. They are aware that there's a large economic cost to the organization over this issue, with increasing data on the links to turnover, productivity, and patient satisfaction.

We need to engage them and say, "Look, these are the top two or three things that are the most simple and actionable in my local work environment that we need to fix." Then we need to work with them to prioritize those things and whittle away at them one at a time.

We all also need to look in the mirror. We, as physicians, tend to be very hyper-self-critical. We're more compassionate and supportive of our peers than we are with ourselves.

We often hold these unrealistic expectations of being the perfect physician, the perfect wife or husband, father or mother, friend, or person in the community. We are quite harsh with ourselves if we don't live up to perfection.

Patel: We've been indoctrinated.

Shanafelt: I think that's the situation. We should treat ourselves with the same compassion we give our colleagues.

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