Doctors Look For A Way Off The Medical Hamster Wheel

Aug 14, 2013
Originally published on August 14, 2013 7:50 am

I became a doctor to help people.

When I was a medical student, I held the naive and idealistic belief that if I just did good work, the business side of things would somehow take care of itself.

How wrong I was.

Now I'm an internist taking care of all comers age 18 and up. Some days I find myself facing patients and feeling more like a harried airline clerk than a real doctor.

I carry a laptop in and out of each exam room, fretting about entering all sorts of data to document the work I do. It feels as though I'm trying to find seats on an oversold airplane — and someone's going to leave the office unhappy toward the end of the day as all the computer work leads to overtime.

Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place.

It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand.

Government incentives that are pushing us toward computer-based records mean that doctors like me now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. Most have sold practices to larger enterprises like hospitals, leaving the risks of business management to the buyers.

I've thought of bailing myself and entering the so-called direct practice model. I wouldn't take insurance then, and patients would have to pay me directly via monthly subscription

But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, is looking for one. She has made it her mission to find ways to mitigate the drudgery of modern doctoring so that we can find joy in our work.

With funding from the American Board of Internal Medicine Foundation, she and four colleagues (including her physician husband) travelled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals.

Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper. The ultimate goal is a joyful transformation of medical practice. An epigraph in the journal article capture the challenge. A highly accomplished physician named Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better."

Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits — by phone, email or video link — have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sign me up!

Certainly, the well-being of fellow doctors and the efficiency of our practices is of great import to us doctors. But what about patients? Do the ideas in the joyful practice templates translate?

"When you receive care from someone who enjoys their work, it's much better care," Sinsky tells me. "At a fundamental level, what patients want and what doctors want are very similar."

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. Does your doctor type while you talk?

A category Sinsky calls "inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day.

"All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring. We're not living up to our best intentions for patients. Primary care can be the best of specialties."

Here's hoping the ideas on her list are the fast-spreading type.

Schumann is an internist and educator at the University of Oklahoma School of Community Medicine in Tulsa, Okla. Follow him on Twitter: @glasshospital

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