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newly elected (and youngest in history) president of the American Medical Association called EMRs, most of which use outdated software, “a point of infuriation” that decimate a doctor’s efficiency and ability to communicate.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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17 comments on “Physician Burnout + Medical Intuitive Skills
  1. MKGilbert says:

    Wow, I didn’t realize that EMR’s were a lot of the problem. HATE when I see the Dr and she’s just furiously typing away…Appts are basically just keeping tabs on me…Don’t get any significant help…

  2. P Woodbury says:

    This’s is what had me walk away from a well paying nursing position. I was criticized for checking vitals myself instead of relying on the aid’s notes. There’s a big difference between “pulse 76” and “pulse 76 , irregular, weak and thready…” Half the shift was point and click while my patients often went three days without a bath unless I overstayed my shift.
    No respect for patients or staff but lots for maximizing profit.

  3. John Cox says:

    For someone not in the health profession, this health tip is informative, humane, and helpful. For medical people, I suspect the response is, “Oh! Yes!” I wish medical bureaucrats would read it and change their ways.

  4. calle says:

    Time for changes folks.
    We need to all start a reverse movement.
    We stay healthy so don’t go to the doctor.
    We do not want to be a part of a “system” out of control.
    Our son goes to an old fashioned doc with a laid back staff.
    A man who has been a medical director, is way past retirement, retired once and came back for a small low key practice.
    They book people so the office is never crowded.
    We can make a difference as health care pro’s if we plant the seeds and have a plan.
    We can call our Reps and tell doc’s and nurses we want quality care back now.
    Some feel that once the fox has found a way into the hen house there is no going back.
    There is, we just have to be smart.
    And my land “Where is the AMA!
    Oh forgot they most likely are getting kick backs for being good little boys and keeping their mouths shut!

    I am angry…

  5. Teresa says:

    As I read this, I found myself saying “Yes, yes, yes!” in agreement. I think a lot of working people are in the same boat, not just doctors. I am a teacher, and we are all experiencing the same kind of work conditions and burnout. We are all in danger of losing our souls in this heartless corporate/technological world we seem to be living in now.

  6. Donna Dufner says:

    Couple that with patient burnout and you have real problems and lost opportunities.

  7. John says:

    Thank you Dr. E.,
    I do hope that writing these wonderful health tips and the communication that provides with your patients does help in some small way to push back against the burnout. As so many of your heath tips do, this one again makes clear the problems with having a for profit health care system, especially one so controlled by the insurance industry (which has an enormous profit margin). It feels like our current system can’t be sustainable. When it crashes we can only hope we find a way to make it better rather than let it become worse. Thank you for hanging in there and for Whole Health Chicago. We need more places like it, where doctors at least have a chance to avoid burnout. Being a doctor should be a rewarding profession (I believe that is why most doctors choose that path) rather than one that creates burnout.

  8. Betsey O'Brien says:

    Thoughtful and frightening. Instead of working to create health, doctors must instead manage illness with a relentless focus on financial gain. I am glad you and the WHC staff have chosen otherwise, but I’m very worried about a larger system that cherishes records, procedures and dollars over people. Do you believe there is a way for doctors and patients to come together for change? I can’t believe that a system that sickens its own is sustainable or good for anyone.

    • cliffmaurer says:

      Hi Betsey,
      You know, as I sat on hold for twenty seven minutes the other day (twenty seven!) with an insurance company just to pay my premium, I listened to their automated greeting which was full of suggestions to only use in-network doctors, specialists and pharmacies. This was followed almost immediately with a couple of television ads for pharmaceuticals aimed to persuade patients to more or less steer their doctors to prescribe a high-end, new drug for which we in the medical field know there are just-as-effective and much cheaper generic drugs, just without the fancy (and expensive) patent; not to mention the fact that starting with a simple, natural supplement might often be the way to go anyway which could mean avoiding a pharmaceutical altogether. I think out best defense as patients and physicians is to build relationships with each other that work because of a mutual interest to find health care resources that work for us and not to simply go where we’re told to go. Find a doctor with whom you can have a conversation, not one that meets with you for 4 minutes and throws a few prescriptions at you without actually getting to know you. We’re out there, I promise. And building those types of relationships is what physicians want too.
      Best wishes,
      Dr M

  9. Stephanie S. Hernandez says:

    I think there can be some kind of middle ground. I have found that I have been in more communication with my doctor because of the EMR. I no longer have to call to ask for test results or follow up questions. There has to be a middle road between thorough doctor’s visit with enough time to document the visit. This is a complicated issue and I am not sure what would be the solution. Overall some very good points.

  10. Irene Frederick says:

    Dr. E… I feel soooooo grateful that you and WholeHealth Chicago are a part of my life and health care.
    Thank you for holding true to your beliefs and maintaining your caring/quality practice!!!
    From the Heart… Irene

  11. Nina M. says:

    Good article, Dr. E. I presume the amount of diagnostic errors and patient suffering, resulting from “doctor burnout”, would be staggering. What would it take to change the system?

  12. Kathleen A pepsnik- good says:

    As I read this I counting my blessings that my
    Dr.Edelberg does not click and point.

  13. Martica says:

    I am a patient and was the full-time caregiver to my husband, Don, while he was at home, in and out of the hospital, in the nursing home, and finally, in hospice. How the dozens of nurses, aides, and doctors found it within themselves to give him generous, loving care is beyond my understanding. I lived alongside their stresses, pressures, and pain; saw them reach inside themselves for grace and balance in sharing bad news; felt them struggle to meet their duties. Don and I loved and appreciated each one in the turmoil we shared. Then, last October, I was fortunate to watch the groundbreaking “The Mindfulness Summit” presented by online. The Summit was 31 days of immersion in mindfulness, guided each day by a beloved teacher and practitioner of mindfulness. Because of my experiences, I responded to the meditation by Saki F. Santorelli, Ed.D, director of the Stress Reduction Clinic at UMass Memorial Medical Center, and purchased his book ‘Heal Thyself: Lessons on Mindfulness in Medicine.’ The cover notes say in part, “In this book, Saki Santorelli, director of the nationally acclaimed Stress Reduction Clinic, explores the ancient roots of medicine, and shows us how to introduce mindfulness into the crucible of the healing relationship.” Essentially, he describes the classes and transformations that take place when mindfulness — and therefore, intuition and awareness — becomes the crucible of the healing relationship. This past Christmas, I gave ten precious doctors and nurses a copy of ‘Heal Thyself.’ It may not change the system (we have to do that by demanding something else) but it may help individuals reconnect with themselves, medicine, and each other alongside, of course, the authors Dr. E. mentions in the article. Thank you, Dr. E. May we continue to be open to healing for us all.

  14. H. Marie Peak, Ed.D. says:

    I also hate the pointing/clicking which makes it impossible for the physician to pay attention to the patient. It is unnecessary to answer most of those sometimes silly questions and certainly to answer the same questions at each appointment. I would also like to complain about continuously seeing questions about whether a patient has sought psychological help. Since I am a psychologist I know that those persons who have not seen a psychologist but need to do so are of much more danger/concern to the public. It is also an invasion of privacy and unnecessary to continue to have this kind of query on a health history form!!!

  15. Phillip says:

    What he is really describing is the change that happens from work done by people for themselves (sole proprietors) to work done by people for corporations. That it is novel to the medical field is both an unfortunate blow to patients of good doctors (e.g. Edelberg), as well as rather amusing to people in fields – viz. almost all fields – that have been corporatized for decades. My boss is a famous physician, and listening to him complain about the corporate requirements of the hospitals/insurance companies makes him sound like a worker on an assembly line in 1900, musing of the motivations for unionization.

    • Teresa says:

      As a teacher, I also feel like a mill worker of some sort. Thank you for your thoughtful post. It helped me clarify my own thoughts about this issue.

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