Reconnecting With Patients to 'Rediscover Joy of Oncology'

Liam Davenport

June 05, 2023

Burnout among clinicians is partly fueled by them no longer having the time to develop meaningful connections with patients, argues US Surgeon General Vice Admiral Vivek H. Murthy, MD, MBA. Kindness and compassion should be valued more highly than volume of published papers, he adds.

However, that will require a cultural shift, commented Eric Winer, MD, current president of the American Society of Clinical Oncology. There needs to be a reduction in the "overwhelming" demands placed on modern oncologists, and a greater sense of respect for what they need to do in order to rediscover the "joy" in patient care, he told Medscape Medical News in an interview.

Winer was reacting to the talk that Murthy gave on healthcare worker well-being at the opening session of the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting on June 5.

Chairing the session, Marcella Nunez-Smith, MD, MHS, inaugural associate dean for Health Equity Research, Yale School of Medicine, New Haven, Connecticut, said that she had heard Murthy say "multiple times" that health worker well-being and burnout is an "issue of culture."

"We have to be thinking about what the experience is like" for people taking on the work of caring for patients, she said. "We have lost over time some of our perspective and grounding on the things that matter: kindness, compassion, care."

Exodus of Healthcare Professionals

Murthy said that the issue of burnout has become a "crisis" in healthcare. "We now have people in nursing and medicine talking about leaving the profession in greater numbers than we ever have."

At this point, Murthy, asked the audience of oncologists and related healthcare professionals to raise their hands if they or somebody they know has recently experienced some form of burnout.

The majority of people in the audience raised their hands.

Murthy lamented that this is because burnout has "become too common, and it represents a real threat to the public health model of the country," especially when considering the shortage of healthcare providers, particularly in fields such as emergency medicine and primary care.

Murthy pointed to his 2022 advisory on Health Worker Burnout, which sets out why the issue matters and discusses how the problem can be tackled on various levels, including by the government, healthcare organizations, health insurers, academic institutions, health workers themselves, as well as families, friends, and communities.

Healthcare workers are placed under too much stress, and there are too many barriers in the way of workers accessing mental health support, such as insurance coverage and access, he said.

"The second thing is we also have to look at the quality of the work itself," he said.

"There are no doctors or nurses I know who went into their profession and said: 'You know, one day I want to grow up to be able to chart. That would be amazing.'

"Or, 'I just can't wait to get on the phone about that prior authorization. That's what I've been waiting for.'"

Both comments caused much amusement among the audience members, but Murthy emphasized the serious point that these tasks take up valuable time and "these are the things that actually get in the way of patient care."

That does not mean that those tasks are not important, he emphasized, as "we need to use technology and safe systems to be able to deliver care, but far too often what we're finding is that people are spending more and more time with tasks that take them away from the bedside."

Spending More Time With Patients

Drawing on his experiences as a resident in Brigham and Women's Hospital in Boston, Massachusetts, he said what healthcare teams and patients actually want is "more time together."

He believes that "time at the bedside" is an important factor that will help with reducing burnout, because these interactions with "the very patients we're seeking to serve" offer "sustenance."

A cultural change will need to be enacted to achieve that, however.

"I think we need to take an honest look at our profession," Murthy commented.

"When was the last time you heard about somebody being promoted because of their compassion at the bedside?" he asked. "More often they're promoted because of their publications and research funding."

"It's not that those aren't important but there's such a disparity" within the wider community over "what is valued" in the medical profession.

"Kindness and compassion almost come to be seen as afterthoughts," he added. "Not necessary, but nice to have.

"So I think we have to rebalance as a profession, and that starts with thinking about who we hold up as role models and how we lead ourselves," especially in front of trainees.

Murthy's comments chime with the theme of the ASCO 2023 annual meeting —"Partnering With Patients: The Cornerstone of Cancer Care and Research," as chosen by Winer, who is also director of the Yale Cancer Center, New Haven, Connecticut.

"Having meaningful relationships in meaningful partnerships with patients is why most of us went to college," Winer told Medscape Medical News.

"Sure, there are some who went into oncology because they love the science," he continued, "but I believe that most people are drawn to oncology because of the interaction with patients and families, and the desire to help them through a very, very difficult time."

However, one of the challenges of current healthcare in the US is "all of the demands between the electronic medical records, and reimbursement and regulatory issues."

These demands "have become so overwhelming that it is hard for people to feel that they have time to connect to patients in a way that they'd like," he said.

"And so, I would agree with Dr Murthy 100%, that … taking some of the administrative burdens…off the plate of the oncologists would allow them time to reconnect" with their patients, and this in turn would help with burnout.

He emphasized that this is "not going to be the only solution for enhancing well-being," but it is an important one.

Another issue is to encourage oncology communities to "feel value for what they can contribute" and not be made to feel like a factory worker on a production line.

"I think burnout is less about feeing that people don't have time with patients, and more about feeling like they're not respected, and that they are overburdened, that they can't take care of patients in the way they would want to," said Winer.

Winer believes that changes will require a "global rethink," at least in part, over the philosophy of healthcare in the US.

The concept up to now has been that "everything's available, we spare no expense."

But this is now, in some ways, "a real limitation, as there are more regulations and people are more and more worried about the cost of healthcare, which is totally appropriate."

This concern is coming from all directions, including insurance companies denying therapies, which can be "very burdensome for doctors," Winer acknowledged.

"Part of the solution is for people to work together to develop clinical pathways and guidelines," he suggested.

For that, ASCO can have a fundamental role as "a great convener," he argued, by bringing together "diverse groups of individuals from different fields," and getting them "on the same page."

One aspect that ASCO can help with in terms of health worker well-being is to determine what constitutes a "reasonable career path," Winer said.

In addition, the organization can "figure out what tasks a clinical oncologist should be pursuing and where there needs to be support from others in the system."

"We can really help people try to rediscover the joy in oncology," he concluded.

No funding declared. Murthy and Nunez-Smith report no relevant financial relationships. Winer reports relationships with Leap Therapeutics, Jounce Therapeutics, Carrick Therapeutics, and Genentech.

American Society of Clinical Oncology 2023 Annual Meeting. Talk: A Discussion with the US Surgeon General on Health Worker Well-Being. Presented June 3.

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