Cooling off physician burnout: a story in 5 pictures.

Yelling at the computer, patient on the exam table. Doc’s not happy, ain’t nobody happy.

This is of course the distillation of the frustrated physician at the computer in the corner (you may recognize the physician-actor), with dissatisfaction cascading to the patient. Why does it have to be this way? How did we get here? Well, we are often victims of ‘translational’ thinking, with insufficient ‘transformational’ thinking. What I mean is: just because the doctor carried the paper chart into the room and scribbled on it, doesn’t mean that putting a computer in the room is sufficient. Would we: ask an airline pilot to review the passenger manifest and take tickets? Would we ask the courtroom judge to take detailed notes in the courtroom?

from JAMA: a child’s illustration of their doctor visit: doc at the computer in corner, thanks Elizabeth Toll!

Here, let’s just pile on, with a kids view of their doctor typing away in the corner. What a gut punch. Is this what children (and adults!) think of seeing the doctor now?

the Triangle of Trust: aligning doctor, patient and computer to SHOW, LISTEN, and TEACH

So here is an incremental improvement. Think about bringing the patient down from the exam table (so many stories of doctors calling questions over their shoulder at unseen patients on the exam table!) think about having them sit next to you and talk about what you’re doing on the computer and whether that looks right. Use it as a method of reflective listening.

“Medical Scribing,” “Advanced Rooming,” “Care Transformation,” or “Team Based Care”

Take it a step further with MA’s doing advanced rooming role and also scribing for the physician. This implies a doubling or quadrupling of the MA staff, but can dramatically reduce physician burnout, improve quality metrics and improve throughput resulting in cost neutral staffing in a fee-for-service model, and dramatic improvements in quality in the near-future Value-Based Care model.

Use Speech Rec for your assessment and plan! It is magical!

How about this? Use speech recognition for your assessment and plan IN THE ROOM with the patient. I find it to be magical, when trained and used properly! More on this in another blog post.

Others have talked about the Triangle of Trust and the HUMAN LEVEL (research article) and HUMAN LEVEL (powerpoint).

CMIO’s take? Five pictures — one way to cool off physician burnout. How are you and your organization approaching physician burnout? Let me know.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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