Physician Burnout and the Decay of the Doctor-Patient Relationship

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There's a large increase in physician burnout, larger than has ever been anticipated and in specific fields and there's really no way of helping or defining that clearly in the workplace at this point. Working with insurance companies is extremely difficult and time consuming, the reimbursements is going down, the demand for time is going up and even though medicine that is increasingly complex, the visit time hasn't changed and yet that visit is now occupied by the requirements both of the government and by requirements of the insurers and certainly the electronic health record so that time is shortened for what should be a more complex intervention between a physician and a patient.

It's not just that it's electronic and therefore more different things that have to be done because of that but it's really the diversion of the doctor's focus not just physically to the keyboard but away from the patient because of all this copious data that usually is quite extraneous and irrelevant that has to be completed.

And that really did not begin with the electronic health record, that began in about the late 1980s when the governments and based on a Harvard study to find resource based relative value scale as a result of the effect that there is a feeling that physician's work could not really be quantified.

One couldn't say what a physician did and how much they should get reimbursed, so this new system tries to define how a physician should be reimbursed and yet it has become the standard of practice, even though it has nothing to do with quality. For example in the care of a complex neurology patient and obviously I can talk more easily about neurology, there are about 50 bulleted points I have to complete in order to qualify for the code that would reimburse me for the time that I spent.

And of those 50 points, about five of that talking to the patient, and in a cognitive field such as neurology, if I did nothing but talk to the patient about what was their concern and the surrounding circumstances of their concern, I would know everything that was going on and will probably need half the test that become necessary when you don't talk to patients.

I don't think it's irreparably broken but I think that there are major efforts being made by people who don't really understand that to break that further. Unfortunately we are in an era when the patient is an integer on a spreadsheet and not a human being with human concerns. So there is not enough talk about how we should pay attention to those human concerns and how they should be managed.

There's a nuanced relationship that the doctor has with a patient. There are things that are said and aren't said, and how they are said and how they are not said, often helps the physician understand what the real concerns are that the patient has, and the more time that they are subtracted from that the more black and white, and really like a mechanized relationship it is.

And even though that might be possible, for example, if you have a broken bone, and you see the broken bone on the scan and it has to be fixed. It's really not like this in the cognitive feelings of medicine, one really has to pay attention to the needs of the patient, and when I say the needs of the patient I'm not just talking about their sickness needs, but for example a person may be more anxious.

Another person might be very cavalier, another person might have had an experience where one of his family members had an MRI scan where the machine broke down and he was stuck in it for two hours and the person just cannot have an MRI scan, and you cannot say to the person, that's it! Your time is up, we can't talk about this any further.

This is human medicine.