The things you can control
Marie Brown, MD
Internist and AMA practice transformation officer, Oak Park, Ill.
Brown says that many organizations are well intentioned when they set up mindfulness training or yoga classes for physicians, but that while such programs may be helpful in some regards, they can also contribute to burnout.
“Offering classes without fixing the working environment just sends the doctor home an hour later and exacerbates their time away from their family, and takes away time that could be used for exercise or sleep,” says Brown. “We also know burned out physicians write more prescriptions, send out more referrals, make more errors, order more tests, and have higher readmission rates. In every other profession, the higher the education level, the more control the person has over their day and the work they do, with the exception of physicians.”
Brown focuses much of her efforts on helping doctors find small solutions to free up more time. “They often say, ‘What can I do, I can’t fix the whole system?’” says Brown. “What I suggest is to begin by looking at their practice and the things they control.”
For example, Brown changed how she prescribes medication for chronically ill patients. It’s common to write a prescription for three months with one refill, so physicians are refilling the same prescription every six months. She suggests changing that to three months plus four refills, so that doctors are writing the prescription once per year. “If you do that, six months from now, the number of refills decreases by half,” says Brown. “With that extra hour, you can stop drowning long enough to see what else you can do.”
Another area to examine is the EHR. Brown says doctors need to look at all the notifications they are receiving. She turned off discharge summaries and notifications about tests that did not include results.
“I decreased my inbox by about 50 percent,” she says. “It doesn’t take any resources and doesn’t cost a lot of time. When you are at your wits end, this is something you can do tomorrow.” She also encourages physicians to seek peer-to-peer training on using their EHR more efficiently.
Whenever possible, make sure patients who require lab work have their labs completed before the visit. “That way when you see them, you’ll have everything you need to have a discussion,” says Brown.
“The greatest driver in preventing burnout is being able to deliver quality care, but there are so many obstacles that stop us from delivering it,” says Brown.