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Monday, December 21, 2015

Clinician "burnout." Is HIT a significant factor?

Google "physician burnout" (with quotation marks around the phrase to optimize the findings). Similarly, Google "nurse burnout" as well. Roughly 109,000 and 56,700 search results, respectively this morning.

Not exactly news. When I first came to health care in 1993 for my first of three stints with HealthInsight (at the time known as "Nevada Peer Review"), most of our staff were astute, experienced RNs, who were often referred to as "floor burnout cases."

Back then, there was HIT, but it was mostly administrative/ops "big iron" in the hospitals and fledgling local "PMS" ("Practice Management Systems") in the ambulatory settings. Paper charts were the near-exclusive norm. Workforce cultural "burnout" inducing psychosocial toxicity existed back then as well.

Has the widespread adoption of full-blown Health IT made things worse? (apropos of my lengthy prior post.)

A new Mayo study (pdf) has been published and reported, focused on physician burnout.

Medicine is both a demanding and a rewarding profession. Physicians spend more than a decade in post-secondary education, work substantially more hours than most US workers in other fields, and often struggle to effectively integrate their personal and professional lives. They engage in highly technical and intellectually demanding work that often requires complex, high-stakes decision making despite substantial uncertainty. These challenges are offset by meaningful relationships with patients, the intellectual stimulation of the work, and the satisfaction of helping fellow human beings. Physicians are also well compensated relative to many professions, are part of a fraternity of supportive colleagues, and often enjoy the respect and appreciation of their community.

The cumulative effect of these forces on the personal and professional satisfaction of each physician is unique. Although future physicians begin medical school with mental health profiles better than those of college graduates pursuing other fields, this profile is reversed 1 to 2 years into medical school. Once in practice, physicians have generally high degrees of satisfaction with their career choice but experience high degrees of professional burnout and dissatisfaction with work-life integration. Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness, and a tendency to view people as objects rather than as human beings. Burnout has profound implications for individual physicians and their families. In addition, burnout appears to impact the quality of care physicians provide and physician turnover, which have profound implications for the quality of the health care delivery system...
Well, if you trouble yourself to study the entire paper, this is all you will find alluding to Health IT:
The landscape of medicine continues to rapidly evolve. Technology, legislation, and market forces have contributed to consolidation of medical practices, fluctuating reimbursement, new care delivery models, increased productivity expectations for physicians, and more widespread use of electronic medical records over the past several years.

Page 1601.

So, the problem is widespread and growing, but...
What are the possible solutions to this problem? More than 75% of the physicians are now employed by large health care organizations and meaningful progress will require an effective response at both the individual level and the organization or system level. Health care organizations should focus on improving the efficiency and support in the practice environment. [pg. 1608] 
Oh, boy, "improving efficiency."

More recommendations.
  • select and develop leaders with the skills to foster physician engagement;
  • help physicians optimize "career fit;"
  • create an environment that nurtures community, flexibility, and control, all of which help cultivate meaning in work;
  • establish principles that help facilitate work-life integration;
  • help physicians self-calibrate and promote their own wellness.

Anyone see any issues here?

Relatedly, it's not just about the physicians. Recall from my prior post:

From The NY Times:
When Hospital Paperwork Crowds Out Hospital Care

A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.

She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.

This is not an anecdote about nurses not doing their jobs; it’s an illustration of what our jobs have become in the age of electronic health records. Computer documentation in health care is notoriously inefficient and unwieldy, but an even more serious problem is that it has morphed into more than an account of our work; it has replaced the work itself...
 Read all of it. Again, to what extent is HIT implicated in "burnout"?

Stay tuned.

More to come...

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