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Physician Burnout + Medical Intuitive Skills

Two articles appeared in medical journals and were reported on Medscape over the past few weeks, one on the scary rise of professional burnout among physicians, the other warning about their declining intuitive skills. I’m sure reading them on the same day helped me appreciate how the two are connected.

After a quick mull, I thought there might be a Health Tip in there, especially since so many of our readers are women, whose intuition comes pre-installed at conception. Others of us (male, left-brained, linear me, for example) have to hone our intuitive skills.

Physician burnout
The physician burnout survey was a bit of a shocker to those of us in the medical profession. In a questionnaire sent to more than 35,000 practicing physicians from all specialties, a full 55% acknowledged they were so thoroughly fried they’d leave medicine ASAP if they could afford to. This 55% is almost double the burnout rate of the general working population (28%) and a10% increase from the same physician survey taken in 2011.

In addition, 47% of physicians reported “emotional exhaustion” and just 41% said their schedules allowed sufficient time for personal and family life.

The best part of the Medscape article reporting on the survey are the 207 physician comments that follow. These are generally not accessible to the public unless you have a computer savvy nine-year-old around the house, though since with the internet everyone’s a physician these days you could probably register as a doctor yourself and a Medscape membership would slide through. Be aware that Medscape is free for physicians, though, and prepare yourself for plenty of Big Pharma ads.

Commenting physicians are in full agreement with the survey and generally surprised it’s “only” 55%. Based on conversations with colleagues, the commenters peg it at closer to 90%. From one physician: “The other 45% are lying.” The commenting group is also eager to report the two causes behind the burnout.

The single biggest villain is the cancer of electronic medical records (EMRs) forced upon doctors and hospitals by threats of financial penalties from the health insurance industry and government regulators (Medicare/Medicaid). This isn’t me being a Luddite. The newly elected (and youngest in history) president of the American Medical Association called EMRs, most of which use outdated software, “a point of infuriation” that decimate a doctor’s efficiency and ability to communicate. EMRs appeared well before Obamacare, but because they seemed to arrive simultaneously some blame the outgoing president for them, which is just silly.

It’s hard to convey to the general public why 85% of physicians so thoroughly loathe EMRs. However, the next time you complain that your physician doesn’t make eye contact with you any more, it’s because she’s spending much of your visit pointing and clicking, pointing and clicking, pointing and clicking. You simply can’t watch the body language of your patient when you’re working to get that tiny cursor into a tiny square so you can click “YES: I have inquired about the tobacco usage history of the patient” (this has to be answered at every office visit).

Doctors can’t communicate with each other using EMRs because there are several hundred competing EMR companies and no two systems are alike. EMRs cause most physicians to run behind schedule and on average add two hours (two hours!) of work daily, precious time not spent interacting with patients. As I write, it’s Sunday morning and when I finish this Health Tip I’ll go back and catch up on last week’s EMRs.

A second source of physician burnout is the micromanagement of doctors by regulators in positions of power. Health insurance companies tell doctors exactly what they can and cannot do. Hospital and healthcare “system” administrators, who now employ most of the physicians in the US, press doctors to work faster and generate more income.

An interesting perspective on the concept of stress describes the current situation. You’ll experience stress when you’ve relinquished being in charge of your life and you’re largely controlled by others. This is today’s situation for US physicians. Under the gun from government and insurance regulators, predatory malpractice attorneys, and patients with unrealistic expectations, their professional skills stymied by the relentless point/click/point/click, if they had enough in their IRAs more than half this country’s doctors would delightedly exit the health care stage and head for the wings of early retirement.

In case you’re curious, I myself am not in the 55%-of-doctors burnout group, though I readily acknowledge being among the 85% who loathe EMRs. I avoid burnout because we at WholeHealth Chicago remain highly independent of insurance (except for Blue Cross), government, and big medical group management. My relationship with Blue Cross is more like the one between a crotchety married couple or two porcupines attempting coitus than between a doctor and an insurance company.

So how does intuition come into play?
If you think about your own intuitive skills, you’ll appreciate they’re the result of attentive observation and a complex, but mainly subconscious, mental activity. When you know in your gut that you’ve found the right person or the perfect house, or that something is truly right or wrong, you’ve reached this point by a Google-quick scan of everything you’ve ever experienced in your life, which you retrieved from ports unknown. But the real name of the game is attentiveness. It’s for good reason that highly intuitive people are also called “sensitives.”

The title of the Medscape article, “Professional Intuition Under Assault,” is best summarized by a quote attributed to Albert Einstein. “The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.”

In other words, what’s responsible for burnout–EMRs and micromanagement–is causing your physician’s intuitive diagnostic skills to atrophy.

Personally, I know that when I or any of my WholeHealth Chicago colleagues are with you, the patient, we’re using all our skills, clinical and intuitive, to figure out what’s wrong. Likely you made your appointment because you yourself had an intuitive insight that something wasn’t right. You may have tried your diagnostic luck on the internet and, coming up blank, you arrived at WHC for some professional help.

I know that each of us can hone our intuitive skills and I recommend the Four Horsemen of Intuition–Carolyn Myss, Norm Shealy, MD, PhD, Christiane Northrup, MD, and Mona Lisa Schulz, MD, PhD, if you want to learn more. I cannot imagine functioning as a physician without bringing into play what I learned from them.

I’m certainly not alone in this. As physicians mature professionally, they realize medical school facts, useful as they are, take a back seat to attentive listening and observation. Doctors may not use the actual word “intuition,” but a majority of them are fully cognizant of using this skill.

I would be burned out too if I were told, “No time for that intuition nonsense. Finish your EMRs. You missed dozens of the point/clicks. And by the way, you’re not working fast enough—be a team player, see five patients an hour, and try not to fall behind. We wouldn’t want to let you go.” In fact, I’d be out the door.

Be well,
David Edelberg, MD

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3 comments on “Physician Burnout + Medical Intuitive Skills
  1. calle says:

    And the beat goes on!
    Where were the legions of MD’s, ND’s DC’s and DO’s when big what ever came marching in and said…”Hey folks we are going to steal your life, time, soul and ability to heal and listen and think”?
    Medicine is part Science, part Art, and a huge dose of Soul!

    We have all lost!
    Next will come the “Auto Doctor” plug your finger into a machine and the doc will hand you a Rx on the way out the door. No conversation no touch no eye contact, just a body.
    The Tech’s are the ones who really get to know the patients.

    Best Doc, keep breathing, we need your input.


  2. Thank you, Dr. E, for a thoughtful post. If EMRs do not facilitate sharing of records among docs, I can’t quite see the point of them. Especially if there are multiple software vendors. This recordkeeping, like so many other things in modern medicine, MUST be standardized and streamlined in order to deliver the benefits they promise. Maybe patients need to demand reform. Physicians may be reluctant to do it, but they deserve our support.

  3. Kathryn Donahue says:

    Ha. And that is a sad “ha” indeed. As a recently retired critical care nurse I see in this article one could easily switch the noun “doctor” for the noun “nurse” in every sentence. The EMR bookkeeping that is required by those who have no clue as to the work medical professionals do is a dangerous burden to those professionals and their patients. It is also driving those burned out professionals out of healthcare. And the question is then asked, “why do we have such a shortage of doctors and nurses?” I say, look to extreme frustration and inability to accomplish the caring and safe practice that brought that individual into the heatth profession. Look to the profit driven corporatization of healthcare, and the unthinking and wasted energy of EMR little box checking. Thank you for a spot on commentary.

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