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By Renée Smith
According to the Physician Foundation’s 2021 Survey of America’s Physicians, COVID-19 Impact Edition, out of more than 2,500 physicians, 61% of overall respondents reported feelings of burnout. That’s compared to 40% in 2018.
While physician burnout may be currently at an all-time high, it was still substantial before COVID-19. Along with patient care, providers face a large number of bureaucratic tasks including comprehensive documentation for Electronic Medical Records (EMR) and Electronic Health Records (EHR), which can be overwhelming.
Michael Schoof, MD, a family medicine doctor in Omaha, Nebraska, has experienced several episodes of burnout in his 28-year career. During those times, he says, the well ran dry and he felt as if he just couldn’t give anymore. His stressful life involved seeing patients for nine hours per day in clinic, eating dinner with his wife and four kids for about an hour when he got home. and then heading to his computer to face a mountain of documentation work every night.
“I wasn’t a happy person to be around,” Schoof says, adding that he felt a lack of mental clarity and joy in his life and was just keeping his head above water with work and family.
Burnout isn’t merely physical and emotional exhaustion. It also includes compassion fatigue, whereby a doctor feels cynical and may start doubting the use of their work, according to Dike Drummond, MD, Founder and CEO of TheHappyMD.com, a business focused on stopping physician burnout.
“Your little voice says things like, ‘What’s the use? My work isn’t making a difference,’” Drummond says. “When things get really bad, the doctor will start to doubt their original decision to go to medical school in the first place.”
Among the most important things physicians experiencing burnout need to know is that feeling overwhelmed and overworked doesn’t mean they aren’t tough enough or trying hard enough, says Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association.
“In fact, physicians are a highly resilient group, significantly more resilient than the general population,” Sinsky says. “If you are feeling stressed or burned out it isn’t because you aren’t resilient enough.” She added that while burnout manifests in individuals, it originates in systems. It’s the health care system that needs fixing, not the health care worker.
Schoof got professional help to improve his mental health, left the residency program he had been leading, and is now a medical director who heads up and supports 20 primary care clinics across the Omaha metropolitan area. He also continues to practice — but now uses the services of a virtual medical scribe to capture what is going on in the exam room and document care in the EHR, which he estimates saves him about two hours of work each day he is in clinic.
Virtual scribes listen to and document patient encounters remotely, allowing physicians to focus on their personal interactions and freeing them from time-consuming paperwork. Another option is to use an ambient clinical intelligence solution, such as Nuance’s Dragon Ambient eXperience, or DAX for short. DAX captures the patient-provider conversation in the exam room and creates clinical documentation automatically.
Here’s how it works: A doctor has a conversation with the patient and family members in the examination room and DAX, through a dedicated mobile app, uses voice-recognition software to capture the conversation and then convert it into a clinical note that’s input into the EHR.
“It’s much more than just a speech recognition system,” says DAX general manager Kenneth Harper. “It’s actually an AI system that can understand the context of what’s being discussed – the technology is able to automatically figure out how to write that document based on the context of a conversation.”
Nuance also develops Dragon Medical One (DMO), a cloud-based speech solution that physicians can use to dictate what they want in each section of a clinical note.
DMO and DAX can be used alone or together in a clinic workflow. For instance, if a doctor is pre-charting before the appointment begins, they might use DMO to put very specific information into the patient’s chart or review pertinent historical data. When they walk into the exam room to have a conversation with the patient, DAX takes over and writes the rest of the clinical document based on the context of what’s happening in that room. After the patient visit, the doctor can use DMO to make adjustments, such as adding addendums, placing orders, and creating follow-up tasks to ask the patient in future visits.
“Doctors are really burned out right now and these are the types of solutions that are making a difference in how they practice medicine,” Harper says. “Doctors don’t want to write documentation — they want to focus on listening to their patients, determine their diagnosis, and get them on the right treatment plan. We hear all the time that this is allowing them to connect with patients and enjoy practicing medicine again.”
But tools like these are just one of the puzzle pieces when it comes to addressing burnout. Drummond says recognizing the symptoms of burnout, rather than writing it off as a case of run-down batteries, can help. And so can sharing the struggle.
“Find someone — usually a colleague or a coach — who can understand what you are going through,” Drummond says. “Take a break if you can. Take really good care of yourself and get some rest when you are not on shift.” Mindfulness training and building skills to manage stress in real-time can also be useful. Through TheHappyMD.com, Drummond offers a video series called One Minute Mindfulness Training, intended to help physicians learn to be relaxed, centered, calm, and focused, no matter what is going on around them.
One thing is for certain: Whether it’s at the individual level or systemic, change needs to happen. If physicians are chronically stressed by their work, it’s essential to rethink the way they practice and modify the conditions of their jobs. The payoffs include not only a happier doctor but also more satisfied patients, fewer medical errors, a lower malpractice risk, and better quality health care for everyone.