Rheumatology at the crossroads
Rheumatologists are informed that — as a group — we are “happy” outside of work, but relatively “unhappy” in our practices when compared to other specialties. Personally, I am experiencing burnout reading stories about burnout.
Let’s develop solutions. Forego the numbing statistics and build on the suggestions of Jessica Kaffenberger, MD, of Ohio State University’s Wexner Medical Center: “To fight the battle of burnout, an unconventional approach is warranted: let’s build happiness.” Along the way, we can rebuild our empathy and connections with our patients.
Let’s get personal. Take a look at your own practice. Do you spend more and more time at night or on weekends on the electronic medical record? If your progress notes are sent to another practitioner, do they succinctly summarize the important aspects of your patient’s care plan? Or do the 10 or so pages reflect your organization’s effort to inflate every aspect of a routine visit into a comprehensive visit for billing purposes? Are you being asked to see more patients but with less time to connect with them? Do physicians occupy positions of leadership in your institution? Are you valued?
In short, is there a power imbalance in the demands placed on you vs. your autonomy to care for your patients? There is not one single solution to a workplace that erodes your therapeutic relationship with patients, but incrementally, you may be able to move your practice towards “the care of the patient is in caring for the patient,” as Francis W. Peabody, MD, has noted.
First, be aware that you have more power than you realize. As rheumatologists have increasingly given up their autonomy to become employees, know that it is extremely difficult to fill your shoes. Demand for clinical rheumatologists far outstrips supply. Sometimes — and I know this is radical — just say no. If that fails, negotiate. If there is a committee in your institution working on simplifying the role of the EMR in medical practice, join it. If no committee exists, help develop one. A dedicated network of physicians willing to implement change can accomplish a lot. Be persistent: It’s worth it.
How do you increase satisfaction in your practice starting tomorrow? I often dictate cryptic notes into the EMR. If the patient has a cat named Oscar who watches TV, I dictate “cat, Oscar, TV.” When I ask the patient about Oscar while performing a joint count at my next visit, happiness envelopes the room. Perhaps a patient is struggling under family stress of a disputed will. I drop a note on that too.
Additionally, I make a short list of patients I’m worried about. In a free moment, a week later, I call them. The calls build trust. I suspect the calls increase compliance. My patients know that I care about them, and yes, I feel happy when I get off the phone.
What other ways can we build happiness back into our practices? I am particularly interested in hearing from rheumatologists who have developed innovative ways to nurture the physician/patient relationship. If you have comments or suggestions, please contact Chuck Radis, DO, at email@example.com.
- Kaffenberger, J. Rediscovering the Happiness in Medicine: Think BIG. PracticeUpdate. September 2019.
- Medscape Physician Lifestyle & Happiness Report 2019. Accessed May 3, 2021: https://www.medscape.com/slideshow/2019-lifestyle-happiness-6011057.
- Peabody, FW. JAMA. doi:10.1001/jama.1927.02680380001001.
- For more information:
- Chuck Radis, DO, is clinical professor of medicine at the University of New England’s College of Osteopathic Medicine.
These are wise words from Dr. Radis on strategies for burnout treatment and prevention. There is clearly no quick fix for burnout, but most agree that the solution requires a “group effort”. First for those who are employed by health care institutions, our employers must make bona fide efforts to make our lives better. I could count the ways, but I know you all know what I am talking about: work-life balance is not possible unless this happens.
The second solution lies within us as individuals who must reflect and work on cultivating life habits such as those described in his commentary, which can serve to buffer us as well. One does not work nearly as well without the other.
– Leonard H. Calabrese, DO