I am a third-generation physician actively engaged in training the next generation of physicians, and I am very worried about health care in our country. Patients and families are clearly struggling, as demonstrated by heart-breaking examples provided by our debating presidential candidates during the debates, with an inability to access and afford much needed medical care.
Health-care providers are struggling in the current system as well. For far too many doctors in this country, burnout is reality, as the physician Danielle Ofri recently attested to in the “New York Times.” While the language and vocabulary surrounding this discussion of burnout is new, physicians have always been affected by the difficult and distressing aspects inherent in taking care of patients.
The ability to publicly admit to burnout — a cluster of symptoms described by Christina Maslach in the 1970’s that includes emotional exhaustion, cynicism, depersonalization, and a lack of sense of accomplishment at work — is a modern development that parallels the dramatic changes in how health care is delivered to the public.
Conservative estimates suggest approximately 50 percent of American physicians experience at least one of these symptoms. While this is not news for the country’s doctors, patients and families are likely to be concerned and even terrified by this startling revelation.
The physician burnout crisis that has spilled into the public conversation might actually be a blessing in disguise. Patients are now hearing about the struggles their physicians face, but doctors have silently been battling burnout all along. Patients may not realize that physicians care deeply and that our system is harming them as well.
Ideally this might provide an opportunity to drive a patient-provider relationship closer towards a partnership. By recognizing the humanity of physicians, patients can use that awareness to communicate and connect better with providers. Personal connection improves care in all sorts of environments. The patient:physician relationship is arguably one of the most crucial relationships we develop.
What is a patient to do then when faced with the current reality that half of the providers they will meet are struggling to keep themselves above water? I have developed three solutions to facilitate connection and engagement between any patient and physician.
The symptoms of burnout are potentially terrifying for a patient to read, but there are easy and realistic steps they can take:
1. Ask you provider if they are ready to hear your story. If the provider is harried, running late, distracted or fighting with the electronic medical record, a simple, “Let me know when you are ready for me to begin my story” may allow the provider to slow down, refocus and engage in a manner that was not possible without kindly calling out the distraction. In my experience, I have found that while physicians are distressed about health care, they are emphatically clear that the distress is not about the patients that they care for. Physicians are rushed all day, every day. When we sit down with a patient it can require a few seconds to transition from the chaos to focus our attention.
2. Bring a clear “ask” to your appointment. Be ready for the physician to ask what they can do with the limited time available. Our health-care system makes it incredibly difficult for physicians to provide the best care for patients. Despite this, all the doctors I know want to get their patients the right care, medication, and procedure. They want time to listen and get to know the patient. It may take a few visits to meet all your concerns. Be persistent. If you are in pain, tell your doctor exactly how it impacts your ability to function. If you are worried about something or fear something, share that. If you feel like you are not having your needs met, calmly explain that. For an overloaded physician, a straight-forward statement of a patient’s agenda can be invaluable.
3. Keep a copy of your own records, including, test results, consultation notes and allergy and medication lists. While some $36 billion has been spent on electronic medical records, it has created a system with repetitive, out-of-date, and irrelevant data that clutters up every physician’s laptop screen. Meanwhile, critical information, imaging results, and details of prior care are often unfindable. An edited summary of prior health care can be the difference between a high value and a superficial, incomplete visit.
There is clearly no excuse for poor quality care or unprofessional behavior from a physician, but patience with your physician will help them be able to hear your concerns more clearly. In a society where compassion often seems to be on the decline, a determined focus to bring simple kindness back to health care is desperately needed. Health-care providers in this country are hurting in ways vastly different than the patients they serve, and it is most definitely not the patients’ task to address physician burnout.
A lot of attention and effort is going towards helping physicians avoid and reduce burnout, but the reality is that many health-care providers are still struggling to deliver these results. Because of this, a stronger partnership a patient can build with his or her physician is to the patient’s advantage, while the health-care system at large hopefully continues to develop a better model that serves our collective need for health.
Developing a real relationship with a patient is what brings meaning to most of us who have chosen to dedicate ourselves to medicine. Despite the current crisis in health care, that meaning is what gets us up in the morning and prevents burnout.
Lara Ronan M.D. is an associate professor of neurology and medicine at Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center and the program director for the Dartmouth Hitchcock Neurology Residency. She is a 2019 Public Voices Fellow with the OpEd Project.