The Executive Suite: Innovation should mitigate rising burnout

How often do patients ponder—and worry about—the emotional condition of their physicians? Rarely, if ever. After all, when a patient is sitting across the desk from a physician, or having a conversation in an examining room, most people are hyper-focused on themselves.

The world understandably rotates around each individual’s own needs, fears, and anxieties. Everything about the physician’s office setting elevates him or her to a figure of authority, thus deflecting patient consideration of their physician’s state-of-mind. In this regard, I was intrigued to read that a research study, published in the American Journal of Medicine, found that 76 percent of those surveyed preferred their doctors to be garbed in white coats, versus just 8.8 percent in business dress, with casual dress coming at just 4.7 percent.

Although patients aren’t always focused on the emotional status of their physicians, medical institutions—in fact all of society—should be. Underneath this formidable display of authority and confidence lurks the dangerous and toxic burnout crisis, first identified and categorized by the under-appreciated Herbert Freudenberger back in 1974.

There are many descriptions for the condition, but this one from a paper published in the Journal of Internal Medicine is particularly crisp and alarming:

“Physician burnout, a work‐related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment is prevalent Internationally.”

Just like children tend not to know what their parents are going through, patients are similarly in the dark; yet, the burnout issue has been well-documented over the years, long before the COVID-19 pandemic and its extraordinary demands. A recent, longitudinal JAMA study found that “50% of physicians in the United States experience burnout, now considered by many experts to be an epidemic.” The paper adds that “Burnout rates are higher for physicians engaged in the front lines of care, including family medicine.”

Ironically, broad-scale EHR adoption—which is a positive trend—is having an accelerative role; the JAMA piece goes on to note that: “The higher burnout rate documented in 2017 may be consequent to the implementation of a new electronic health record (EHR) across the institution.” Since then, EHRs have achieved even broader proliferation. A recent “Ideas and Opinions” piece in The Annals of Internal Medicine by medical doctors N. Lance Downing, David W. Bates, and Christopher A. Longhurst points out that while burnout is multifactorial, the physician’s interaction with electronic health records (EHRs) is especially important. The reality of what is called “desktop medicine”, which forces physicians to spend as much time with their computers as with their patients, must be reckoned with.

A recent study published in Annals of Internal Medicine, reporting on EMR time among outpatient physicians, reported that 33 percent of critical EMR time is spent on chart review. This is a situation that we don’t have to accept as inevitable. NASEM supports the need for innovation. In a report published last month they recognize that given the volume and breadth of necessary data to inform care, automated tools are needed to make sense of data, identify clinically important data, and improve care. More than any specialty, primary care needs for this information aggregation and analysis to be automated. The current digital health environment makes this an impossible task.

The report also urges innovation in artificial intelligence to parse relevant data, understand implications and interrelationships of data, and aid decision making and health promotion. I couldn’t agree more, as artificial intelligence and machine learning is currently available that can dramatically reduce the mental pressure that results from scattered data that resists the quick assessment physicians must make.

It’s important to note that this chart review crisis is different from the stress of documentation and administrative work, which is why it can't be fixed by hiring more people. They can reduce the documentation struggle, but non-physicians can’t relieve the cognitive struggle. Only doctors can connect the dots, reviewing medical histories, lab results, consult notes, and all the other critical signals that trigger conclusions and next steps. What’s more, chart inflation will only continue as the volume of data from wearables, chatbots, and other inputs are unstoppable. Cognitive burden meets digestion blockage! Only AI can cure it.

Make no mistake, the ability of EHRs to replace time-consuming, often accurate, and unshareable paper documentation with digital platforms is an extraordinary innovation. But it’s just one step; the history of technology, at its best, is when innovations build productively on each other, bettering the world in that process.

This ever-increasing ability of technology to unlock the full potential of data at the point of care is an essential “burnout buster” that will reduce missed diagnosis and care gaps, increase quality compliance, create a more meaningful physician-patient relationship, and will ultimately improve the overall quality of care. Its arrival is not a moment too soon.

Doctors are human beings. Excessive demands on them have profound emotional consequences. The pandemic is only exacerbating that. All of us who support them must do what we can so that these dedicated human beings can help those who reply upon them. Replacing lost hours of “desktop medicine” with meaningful hours of patient medicine is an important step in that direction.