Maintaining purpose in medicine
Most doctors start out in a noble intent, many bring passion of the heart to medicine. – Dr. Paddy Barrett, The Doctor Paradox
The quest for efficiency and productivity in healthcare has changed the practice of medicine. The work of physicians has changed dramatically. On his podcast, Dr. Paddy Barrett says, “We create enormous gains in efficiency, but the individuals who are components within it begin to lose sight of ‘the overarching purpose’ of what the organization is about. It is the loss of that perspective which has significantly harmed our ability to get the value out of our day-to-day interactions that we often miss.”
I think purpose is a balance between the personal relationship and the outcome we are trying to achieve.
The EHR, in its current form, drains energy away from the doctor-patient relationship. This upsets the balance. It puts added stress on the physician, who exists at the fulcrum of that balance. That stress, over time, leads to anger, burnout, resentment and loss of purpose.
Physicians are spending more of their time struggling with burdensome electronic health records than they are providing direct patient care. And, in the process, doctor job dissatisfaction and professional burnout is growing. – Health Data Management
For every hour a physician spends with a patient, he spends two hours dealing with documentation, according to a study in the Annals of Internal Medicine. Christine Sinsky MD of the American Medical Association says, “Despite spending half of the work day on EHR/clerical work, physicians are still taking home one to two hours of data entry work at night and taking time away from their families and friends to complete these clerical tasks. This is not sustainable.”
The reality is many physicians have left or are considering leaving medicine. Others are trying hard to reconnect to the reasons they became physicians in the first place.
A Mindful Practice
Finding purpose in medicine is about creating meaningful relationships that result in healing. Sometimes, in the process of healing, the healer becomes healed as well.
We can start reconnecting to our purpose by reconnecting with ourselves. Dr. Robin Youngson, an anesthesiologist and international advocate for compassion in healthcare, studied the reasons some physicians were able to flourish where other physicians were burned out.
He found mindfulness, intentionality and a shift in attitude are the most powerful hallmarks of those who are joyful in their work.
I have practiced mindfulness for a while, but recently, a patient of mine, who has survived cancer, started teaching me Tai Chi. Personally, I’ve found the slow, purposeful movements of Tai Chi to be very calming and helpful.
There is no question that this imbalance is not only a risk to physicians but to the direct care of our patients. On Dr. Barrett’s podcast, Dr. Youngson shares wisdom for “Rehumanizing Healthcare.” He says, “We have an enormous amount of evidence-based medicine about the treatment of disease, but we have almost no evidence-based medicine at all for the caring of human beings.” In the last decade, he has been collecting research and evidence on how heavily compassion and caring can influence clinical outcomes.
High empathy surgeons linked to good outcomes
In one study, trauma victims were asked about patient-centered outcomes six weeks after surgery. Patients were also asked to rate their surgeons on levels of empathy, from high empathy to low empathy.
“Patients cared for by high empathy trauma surgeons were 20 times more likely to be in the group associated with good outcomes,” says Dr. Youngson.
The quality of your presence
In another study, two people were placed in close proximity to each other, one hooked up to an ECG heart rhythm monitor, and the other to an EEG brain monitor. Their wave forms were monitored. After 15 minutes, evidence showed that neurons in one person were firing in synchrony with the heartbeat of the other, and vice versa. “We have this heartfelt connection, the mirror neurons, empathy, and the ability to sense,” says Dr. Youngson.
What this means is when you are in a caring relationship with a patient, you are actually changing the physiology of the patient right in front of you within minutes just by the quality of your presence – regardless of the words you use or the treatments you give. – Dr. Robin Youngson, HeartsinHealthcare.com
Dr. Youngson says he sees this as an anesthesiologist, “A frightened patient comes into the operating room –heart rate is up, blood pressure is up – and the quality of my presence can settle down the patient’s numbers before I even give a drug.”
This only works when people are physically close together. We don’t yet know what affect technologies like telemedicine will have on our overall health, but we can start thinking about it.
Reconnect to the heart of your practice
Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine. – Christine Sinsky MD, AMA
Dr. Youngson advises physicians: “Reconnect to the heart of your practice. Get back to your earliest and deepest hopes, ideals and aspirations of why you came into medicine. Learn how to be more mindful. Learn to be more sensitive to the kind of presence you are bringing to patients. Give people the gift of time.”
Dr. Sinsky says doctors who have some sort of EHR documentation support are able to spend a greater portion of their work day providing direct clinical face time to their patients. Even having the luxury of a medical scribe, however, does not solve all of these challenges.
What other ways might we address this challenge? Let’s work together to find solutions. Link to #HITsm topic questions.