EHR and Other Health Technology Are A Key Driver of Physician Burnout
I know that I’ve been gone for a while, school starting up has been a huge drag these past 2 weeks. Things just picked up speed way too quickly and smacked me before I even realized what was happening. Before I knew it, I had exams, projects, assignments, and presentations already looming over my head. Fortunately though, I was able to hold on through it all and now that I’m through this first hump of the semester, I can take a step back and breathe. Now, let’s finish up this little series regarding physician burnout because I have a couple of new topics that I want to be able to get through as well! Talking about EHR and other health technology will probably be the last post in this series, and then I’m going to try and do a “so what? what are we supposed to do?” post. It’s one thing to just point out problems, but I’m going to try and recommend some solutions to help alleviate the amount and severity of physician burnout. Unfortunately, there will never be anything that will complete prevent, but the best that we can do is ensure that we are controlling and maintaining our emotions and feelings.
We’ve already established that burnout is real. Of all domestic careers, being a physician is one of the most traumatizing and stressful careers along with those in emergency services, military personnel, and public services and anyone that says otherwise is just spouting out BS. When I was working as a medical scribe, on a weekday night, at a relatively small community hospital, I would have 12 straight hours of running from room to room, filling out paperwork, charting the notes and observation, and helping out the physician with everything they were trying to do. But what made it worse is the amount of time I would have to spend clicking checkboxes, picking choices in dropdown menus, and writing in short phrases due to a limited text box space all to read an incoherent chart because of the ridiculous way that the EHR programs would piece everything together through its “groundbreaking algorithm and predictive diagnostics”.
It’s already bad enough that I had to encounter patients that were literally fighting tooth and nail with everybody just so they could sleep in a warm bed for the night. It was already bad enough that people would be rushed into the ER due to complications of breathing and chest pains all to suddenly have their problems resolve and scream for pain medication. There is a reason why there has been such a huge push in regulating and controlling pain medications to patients, especially the opiates. It was already bad enough when we would get patients that were visibly morbidly obese and smoking 2-3 packs of cigarettes a day, complaining about their problems breathing and overall fatigue, contributing it to everything and everyone else but their own personal accountability of trying to change their lifestyle. When we would try to sensitively mention possible lifestyle changes, voices would be raised, curtains would be pulled down, and curses would be thrown in every direction complaining at the laziness in the medical staff at trying to pin their “life-threatening condition” on their 12 morning beers or 400+ pound weight.
Anyways, enough ranting… but the worse part was when we would receive complaints from the patients saying that we aren’t giving them the necessary attention and interaction because our heads are cricked over the computer typing away, without any eye-contact. And quite frankly, that problem is on us. In truth, it’s because EHR and other health technology are so poorly designed and implemented that medical scribes EVEN have a job. If EHR were actually well designed and were actually conducive to healthcare provider workflow, why the heck would the doctors even need a medical scribe to help them with it all? When I was first hired, the doctor that I was first assigned to walked up to me, shook my hand with a smile and just said ‘thanks bud, I appreciate everything that you’ll have to suck up for me”. I just laughed at that, but until I actually started doing solo charts, did I realize why medical scribes were so necessary. Everything was so confusing, nothing made sense, and this supposed “advanced EHR” looked like it was made in 1997. I had the chance to talk to the doctor and he was telling me how “despite being a young blooded doctor, this technology was out of my league” and how it took him a long time to figure out how to navigate around the software and it really threw his numbers of “patients seen” down considerably because he would have to spend 10-15 minutes after a patient to write up the chart instead of going to see the next patient, which I thought was bad. Just speaking with the other physicians, nurses, and ER technicians that I had the chance to work with, they all said the same thing, they were all frustrated and angry at the “POS EHR” until companies decided to throw a tiny little bandaid at them in the form of medical scribes, but at the time it didn’t really mean much to me because I found it relatively easy to pick up and write up my charts so I kind of scoffed them aside.
But when I had the chance to work with an older physician in his late 60’s, he really showed me the real reason why there was so much discontent for this “new and emerging technology”. He took me aside one shift, and showed me his own paper notes that he used to take just a couple of years before, and they were clear and descriptive as can be for a doctor’s handwriting. But when he showed me how the EHR software would compile and “piece” together all of the checkboxes, dropdown choices, and additional words he would type, it ended up being worse than an Mad Libs filled in by a kid who couldn’t even write yet! Nothing made sense. More than 70-80% of this chart didn’t really seem to add any value or indicators for the patient other than just needless fluff words meant to make the charts look “professional” and “fully written”. This older doctor told me that without the medical scribes, his average of seeing 25-30 patients in a shift would have dropped to seeing at most 15 patients in a 12 hour long shift. He was by no means technology illiterate, but seeing him hunched over a tiny little laptop trying to find all of the keywords and adjectives made him look like Quasimodo overlooking the city from his perch. But he said something that really stuck with me since then, “I’m a fan of technology that makes life quicker, more efficient, and raises industry standards.” Although that sounds blatantly obvious, this was coming from a going-on-70 doctor that had to ask me every 10 minutes to decipher the text messages he was getting from his granddaughter (Miss you doc! <3), but even then he wanted Health IT and the EHR to be good, he wanted to use them because he knew how they could benefit, but he was constantly disappointed by the poor implementation and management of these EHR companies that were releasing subpar products due to the lack of clear-cut standards. He knew that nurses sometimes struggled with reading his handwriting for prescriptions, he knew that having to rifle through pages on pages of notes on a patient’s chart could be an eyesore, and most importantly he recognized that this would hopefully pave the way in improving quality patient care. But instead, he talked about how he became a “glorified desk jockey” that had spent more time looking at a computer screen than at a patient. It wasn’t until then did he tell me that he did medicine because he enjoyed direct patient care and human interactions but since the introduction of EHR, he was becoming more and more disillusioned and if it wasn’t for personal circumstances, he would have retired long ago and not have to deal with the “clusterf*ck” that is medicine today. Gone were the days of “firm and kind hand clasps” and the “caring eye contact”, all the hands and eyes were good for now were typing on a keyboard and clicking on boxes.
But the truth is, healthcare organizations shouldn’t have to be relying on the temporary relief of medical scribes. There should be pressure on these health information technology companies to actually push out a well designed and work-flow conducive production for everybody in the hopes of increasing efficiency for everybody, detecting anomalies, and overall, improving patient safety with quality standards. One thing is clear though with all of the healthcare providers that I’ve talked to though, having to spend more than half of your time staring at a screen have made them start to feel more indifferent towards medicine, which they realize is bad, especially for the patients involved that they’re seeing. Simply put, the increasingly poor electronic nature of medicine is making these once bright-eyed and impassioned providers feel burnt out. In fact, in this article, they mention that:
- 44% of physicians were disatisfied by the implementation of the EHR and other health information technology products.
- 63% of physicians thought that the technologies made them less efficient.
- 41% of physicians did not believe that the technologies helped to improve patient care.
- 56% of physicians did not believe that the time spent on the technologies was beneficial in any way for the patient
Despite the discouraging statistics, physicians are still supportive of the possible health technologies. AMA President Steve Stack, MD, says that, “Doctors will get behind things that support better quality of care and support them in their clinical practice. It’s the nonsensical stuff that makes it infuriating and challenging.” We all see the potential that EHR and other medical technology can provide, it’s just that our expectations were dashed with crap releases one after another. I’m probably a little biased because I have one foot in Health IT as well, but I believe that with the right policy implementation, management, and standards creation, can EHR truly be a valuable tool for everybody, not just for the patient and the provider! But unfortunately, I’ve also had to face the difficulties that many other physicians have faced as well.
Even with someone that I know, they can’t just shut off work at the end of a Friday worknight, nope. Instead this person brings back all of their work, the paper notes that they took, and they trudge through the charts over the weekend to ensure that they’re finished so that those working on the weekend are provided with an accurate representation of the patient. Instead of taking that downtime during the weekend to relax, the work is constantly on their mine and on their hands. In fact, Stack goes onto say, “That downtime is important so that they are emotionally recharged so when they go deal with patients who are suffering or are facing catastrophe in their own lives, they have the emotional reserve and energy to be strong and supportive of the patient’s needs.” Furthermore, he goes onto mention that at any time, there is usually 1 in 3 physicians facing burnout in general. But most of the factors that have led to these physicians feeling burnout are due to larger factors and/or bureaucratic red tape, but health information technology does not have to be a part of that list, if there is just solid and key communication with the vendors, the government in regards to reporting standards, and the healthcare community, there can be pushes towards improving the technologies without anyone feeling like their concerns are not being met or their own personal time is being infringed upon.