It will perhaps come as a surprise to no patient that being a doctor is a demanding job. While challenges vary, from the whirl of an emergency room to the absolute precision needed in the operating suite, physicians — as a group — certainly have their work cut out for them.
Today, in addition to the care they deliver, doctors routinely face an enormous documentation burden, including entering data into an electronic medical record for every patient they see. There are pressures to see more patients, and to remain accessible electronically like through email to handle issues as they arise. Many doctors also bemoan a loss of autonomy as they seek to satisfy requirements of health systems (with fewer in independent practices), governmental regulators and insurers, to receive reimbursement. And as a result of these and other factors, burnout has become a significant problem. Research finds that around one-third to more than half of physicians report experiencing it at least in some form — and nurses, similarly, report it at high rates.
Burnout is often thought of in three parts, with emotional exhaustion being a central facet. In addition to the feeling of exhaustion or depression, the second component is depersonalization, “which is the feeling of cynicism, of coldness, of not caring,” says Dr. David Meyers, chief medical officer at the Agency for Healthcare Research and Quality. The last component involves not finding meaning in the work, “or a lack of a sense of accomplishment,” he says.
[See: 5 Common Preventable Medical Errors.]
Taken together, these feelings can lead some clinicians to leave medicine and even, in some cases, contribute to physician suicide. Not unsurprisingly, research increasingly finds that burnout may also affect the quality and safety of treatment patients receive. All the components of clinician burnout are, of course, decidedly negative, but the potential impact goes beyond that. “From a patient perspective, if your doctor or nurse doesn’t care about you anymore, can’t emotionally relate to you, is cynical or cold, it really hurts your ability to trust them and get better,” Meyers says. AHRQ notes, “Burnout can … threaten patient safety and care quality when depersonalization leads to poor interactions with patients and when burned-out physicians suffer from impaired attention, memory and executive function.”
As surveys document rising rates of burnout among physicians, there’s reason to believe patients are also paying the price. “There seems to be a pretty good correlation between physician burnout and the patient’s overall experience,” says Dr. Robert Wachter, chair of the department of medicine at the University of California, San Francisco School of Medicine. “It’s difficult for a burned-out physician to provide the kind of empathic care that patients need and deserve.”
Still, it’s not easy to tease out specifically the impact clinician burnout may have on care. “Many of the reasons why doctors and nurses are burnt out is because they’re working in systems that aren’t functioning well, that are hard to work in — and that’s zapping their will, it’s making them depressed. And so those same systems often have quality problems,” Meyers says. “But as we understand it, when doctors and nurses feel burnt out, they are more likely to make a medical error,” he says. “In units where doctors and nurses show higher burnout rates, there are higher infection rates.” One study found in intensive care units when doctors and nurses reported higher levels of burnout, the death rates of people cared for in those ICUs were higher as well. Experts emphasize that regarding the association between burnout and patient outcomes, it’s difficult to determine if one caused the other and if so, which came first (i.e. when patients are doing poorly that can certainly lower physician morale).
[See: 9 Strategies for Reducing Emergency Room Medication Errors.]
Patients may never know, in fact, if their physicians are suffering burnout. But there’s a telltale sign that something may be amiss that’s central to the negative impact burnout can have on patient care: a poor interaction between doctor and patient. Namely, the physician focuses only on the facts, but doesn’t make that integral connection with the patient. The healing process “improves if you inspire hope, and that comes about with the connection,” says Carolyn Dewa, a professor of psychiatry and behavioral sciences at the University of California, Davis.
Dewa led a research review published in the journal BMJ Open evaluating facets of the relationship between physician burnout and health care quality. “In the literature, there’s a relationship that people have consistently found between burnout and medical errors,” she notes. But questions remain, like how prevalent and serious these errors are and how ultimately they might impact care. Another limitation of studies reviewed “was the reliance on physician self-report data for the assessment of medical errors,” she and fellow researchers noted; previous research has found when physicians are burned out they tend to report more medical errors than an independent audit would suggest actually occurred.
But even as more study is needed to flesh out the potential effects of physician burnout on patient care, the diminishment of the “human interaction,” as Meyers describes it, between doctor and patient is clearly a critical problem. And while it may be reasonable for a patient to be understanding of the demands placed on a doctor, that doesn’t mean flipping roles in terms of who cares for who. “If I’m a patient, I have sympathy [for] my physician’s predicament, but not too much,” Wachter says. “I’m there to get good care; and if my sense is that my physician isn’t paying attention to me, or is really grumpy, or has a short fuse, I’m not sure there’s anything a patient can do…. I’d be looking for a different physician or a different system.”
Many health care organizations and systems are currently investing significant resources to determine what can be done to improve the working conditions for physicians, reduce burnout, and by extension, hopefully improve patient care. “We are spending an enormous amount of time and energy and money in addressing the issues of physician burnout,” Wachter says of UCSF. “We don’t want it to be the case that a patient comes in and has a sense that their doctor is distracted or unhappy.”
Experts encourage patients to raise concerns if the provider-patient interaction or the quality of care seems to be diminished — particularly in the case of an ongoing relationship with a doctor. “Especially in psychiatry, we definitely talk to our patients and we hear from them, and we ask for feedback,” says Dr. Dakota Carter, a psychiatry resident at McGovern Medical School at the University of Texas Health Science Center at Houston, who’s studied physician stress and burnout. That could be given in conversation or written, or anonymous, survey feedback — whatever a patient is comfortable with. If it seems to be a health system-wide issue, Meyers suggests considering penning a letter about it to the CEO of the health system, just as you might to raise other serious complaints that need be addressed.
[See: 10 Lessons From Empowered Patients.]
Of course, physicians are encouraged to prioritize things like self-care, as Carter notes, to ease burnout and help improve patient care. But experts also say broader systemic issues have to be handled to address work-related issues for clinicians that can in turn become care-related problems for patients. “If the care isn’t as reliable and as safe and as high quality as we would want it to be, that’s all of our problem,” Meyers says, “and we have to demand fixes to the system.”
More from U.S. News
11 Things Seniors Should Look for in a Health Provider
10 Questions Doctors Wish Their Patients Would Ask
9 Extra Safety Assignments for Hospital Patients
Is Physician Burnout Affecting Your Care? originally appeared on usnews.com
