Commentary

Focus on the value, rewards of physician-patient relationships

Studies of burnout, depression and dissatisfaction among physicians share one common theme – the problem arises from the environment in which modern medicine is practiced. The studies imply that simply changing the environmental demands of a physician may stave off feelings that the physician no longer practices in a noble profession, but rather just completes daily job requirements.

A breakdown of the physician-patient relationship arises from today’s health care system. We are pressured for time and challenged to run a business with decreasing reimbursement offset by strategies to make up for the deficits. For some, the answer is to become an employee of a health care system, letting someone else manage the environment. However, this environment has threats of its own that affect the physician-patient relationship and has consequences that can also lead to moral injury and burnout.

Anthony A. Romeo

Physician’s conscience

Health care system leaders frequently represent patients in an abstract sense by the category the administrator is managing. For example, some health care systems have up to 50% of referrals from a physician to a subspecialist “leak” from their system when patients see an outside provider. While leaders know they cannot tell physicians how to practice medicine, the tactics may strongly encourage keeping patients within the health care system. The best method to prevent leakage would be to improve the quality of physicians and the referral process, but health care systems frequently use other methods, such as hiring new graduates or purchasing practices, as if its physicians are interchangeable.

These decisions can weigh heavily on a physician’s conscience. When a physician knows the right decision and understands its ethical and moral components, but then violates his or her belief system to benefit the health care system, then there is a high risk of damage to the physician’s psyche.

The war of conscience between patient care responsibilities, responsibilities to an employer, incentives for promotion and financial gain, and the conflict of ethical behavior are most impactful during the early part of a physician’s career. It becomes easier to follow the system as designed later in a career. Sadly, some physician leaders have dissociated themselves from the relationship that first brought them their greatest rewards.

Self-reflection

It is important to revisit why we became orthopedic surgeons and our moral compass at the start of our careers. Such self-reflection helps to not only block out distractions that affect patient care, but also reminds us to develop meaningful relationships through our profession. The relationships are predicated on trust, honesty, empathy and a sincere interest in the well-being of others. We find renewed strength and rejuvenation in these relationships. Connecting with another person on an intimate level motivates one to continue the pursuit of knowledge and improve patient care.

As health care becomes more challenging and stressful, we must focus on the value and reward of the physician-patient relationship that appealed to us when we started careers in orthopedics. No matter the type of practice or business or employment model in which we engage, keeping the focus on what is best for our patients will help us avoid moral injury and its consequences including depersonalization, poor job satisfaction, and ultimately burnout and loss of desire to develop relationships that provide some of the greatest rewards in life.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.

Studies of burnout, depression and dissatisfaction among physicians share one common theme – the problem arises from the environment in which modern medicine is practiced. The studies imply that simply changing the environmental demands of a physician may stave off feelings that the physician no longer practices in a noble profession, but rather just completes daily job requirements.

A breakdown of the physician-patient relationship arises from today’s health care system. We are pressured for time and challenged to run a business with decreasing reimbursement offset by strategies to make up for the deficits. For some, the answer is to become an employee of a health care system, letting someone else manage the environment. However, this environment has threats of its own that affect the physician-patient relationship and has consequences that can also lead to moral injury and burnout.

Anthony A. Romeo

Physician’s conscience

Health care system leaders frequently represent patients in an abstract sense by the category the administrator is managing. For example, some health care systems have up to 50% of referrals from a physician to a subspecialist “leak” from their system when patients see an outside provider. While leaders know they cannot tell physicians how to practice medicine, the tactics may strongly encourage keeping patients within the health care system. The best method to prevent leakage would be to improve the quality of physicians and the referral process, but health care systems frequently use other methods, such as hiring new graduates or purchasing practices, as if its physicians are interchangeable.

These decisions can weigh heavily on a physician’s conscience. When a physician knows the right decision and understands its ethical and moral components, but then violates his or her belief system to benefit the health care system, then there is a high risk of damage to the physician’s psyche.

The war of conscience between patient care responsibilities, responsibilities to an employer, incentives for promotion and financial gain, and the conflict of ethical behavior are most impactful during the early part of a physician’s career. It becomes easier to follow the system as designed later in a career. Sadly, some physician leaders have dissociated themselves from the relationship that first brought them their greatest rewards.

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Self-reflection

It is important to revisit why we became orthopedic surgeons and our moral compass at the start of our careers. Such self-reflection helps to not only block out distractions that affect patient care, but also reminds us to develop meaningful relationships through our profession. The relationships are predicated on trust, honesty, empathy and a sincere interest in the well-being of others. We find renewed strength and rejuvenation in these relationships. Connecting with another person on an intimate level motivates one to continue the pursuit of knowledge and improve patient care.

As health care becomes more challenging and stressful, we must focus on the value and reward of the physician-patient relationship that appealed to us when we started careers in orthopedics. No matter the type of practice or business or employment model in which we engage, keeping the focus on what is best for our patients will help us avoid moral injury and its consequences including depersonalization, poor job satisfaction, and ultimately burnout and loss of desire to develop relationships that provide some of the greatest rewards in life.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.