Wednesday, November 2, 2016

Et Tu, Dr. Noseworthy?




Should patients fire their doctors if they suspect burnout?  In a recent PBS interview, Dr. Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout.  His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession.  In my opinion, firing your physician is a risky proposition in light of the looming physician shortage.  After all, a bird in the hand is worth two in the bush. 

Burnout is an overwhelming sense of disillusionment a physician experiences when the practice of medicine holds no joy.  It is not a psychological problem, yet can lead to a downward spiral of impairment.  According to a recent article in US News, almost half of physicians have symptoms of burnout. Seven percent of physicians aged 29-65 contemplated suicide in the last year.  These statistics are troubling on many levels. 

Over half of current physicians state if given the opportunity to choose again, they would not choose medicine as a career.  Why?  Our once noble profession has lost its magnificence in an explosion of technology, nonsensical regulations, and increased clerical burden.  According to a study in the Annals of Internal Medicine, for every one hour of patient contact, a physician spends two hours doing administrative work.  Never-Had-a-Bad-Day-Noseworthy said, “EHR’s are not easy to use.”  Why are physicians being required [forced] to utilize useless technology if it does not reduce burnout while improving efficiency and care quality? 

Look, we sacrificed our youth seeking delayed gratification that may never come; physicians have responsibility, but no authority, and vast quantities of knowledge, yet no autonomy. Sadly, we have ceded it to arrogant administrators running amok in a system of unfettered capitalism.  Regrettably, this oppression has taken a toll on us all, patients included.

How did physician burnout become linked to increased medical errors?  A study examined the relationship between the burnout experienced by surgeons and frequency of medical errors.  The more exhausted and depersonalized your physician has become the greater your likelihood of experiencing a medical error. 

How common are these so-called medical errors?  Last May, the British Medical Journal released a study ranking medical errors as the third leading cause of death in the U.S., after heart disease and cancer, killing 250,000 people a year. From my perspective, an overwhelming workload also plays a significant role.  A recent study in JAMA found increasing a nurses’ workload from four to six patients increases the death rate by 14 percent, while going from six to eight patients is tied to a 31 percent increase in death rate.  The wheel is turning, but the hamster is dead, literally. 

If a physician is suffering from burnout, let us walk through the conversation Dr. Noseworthy is so naively proposing. 

Patient:  “Doc, You are not as empathetic as you used to be.  I am thinking about changing physicians?” 

Physician:  “Well, what exactly is the problem?” 

Patient:  “Well you used to spend more time with me at appointments and seemed to care.”

Physician:  “I wish there was more time to talk. I sure loved my job back then...”  (Sigh.  Continual tapping of computer keys heard in the background while trying to seem empathetic.)  

Valuing the physician-patient relationship allows it to be a central transformative therapeutic force.  Obamacare expanded coverage for almost 20 million Americans seemingly overnight.  Patient volumes doubled due to the unprecedented surge in insurance coverage?  There were not enough physicians in reserve to care for the overwhelming onslaught especially in underserved rural areas; most of us on the front lines are drowning in paperwork, administrative and regulatory burdens.  Being a physician under current circumstances is like trying to get a sip of water out of a fire hose.  Every physician in this country is on the train barreling toward burnout.    

Last week, I referred four different patients to four different local pediatric specialists.  Three of those four physicians called to let me know they are retiring at the end of the year.  With all due respect to Dr. Noseworthy, at the rate things are going, firing your physician will land a patient in medical limbo until they can find a physician desperate enough to accept them.  This man is so out of touch with reality outside the ivory tower, he is completely oblivious to the larger implications of the looming physician shortage. 

According to the Association of American Medical Colleges report, the projected shortage will reach 85,000 physicians by 2020.  In Will the Last Physician in America Please Turn Off the Lights, three co-authors from Merritt, Hawkins & Associates say the wait to see a physician will jump to three to four months for a non-emergent visits, and it will cost two to three times what it does now–whether you are insured or not. Guess what? I am already at the three month mark for non-emergent appointments and struggling to keep up with the growing patient demand. 

Physicians are resilient to a fault, coupled with stoic demeanors, inquisitive minds, and strongly empathetic natures, but we all have our limits.  Reducing burnout will only be feasible when we have more independence over the particulars of our self-sacrificing occupation.  If every physician in this country insisted on caring for patients as we saw fit and refused to click even one more box, a revolution would ensue.  We must stop “rolling over” when asked to do more with fewer resources, reduced pay, and even less time.  Physicians must put on their own oxygen masks before helping others with theirs.  

Despite his insulting recommendation, Dr. Noseworthy might actually be on our side.   “Physicians are highly dedicated professionals, who are good people, but have been crushed [by the system.]”  Do not allow yourself to be destroyed by a system we cannot control.  Take back medicine for yourself and your patients.  Know your value.  Do not bend to the demands of managers and administrators; refuse to accept a workload that prohibits attaining occupational jubilation and enlightenment. 

There is an impending crisis no one has foreseen; the winds are about to shift in our direction. Rules of supply and demand are universal. Soon, it will be a “physicians market”; we will cherry pick patients based on their having good insurance, a healthy medical profile, and a pleasant demeanor. 

Let us circle back to Dr. Noseworthy, “Change physicians.  It is too risky to be cared for by someone who is impaired.”  You know what is more risky than that?  It is having no physician at all when you desperately need one.  My advice is to build a relationship with a physician while you still can.  If your physician is not empathetic or appears to be suffering from burnout, my cautionary recommendation is to be careful what you wish for, because you just might get it. 










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