Blogged Arteries

By Dr. Manish Naik

This article was originally posted on Austin Regional Clinic's leadership blog.

Doctors see firsthand the toll that today’s increasingly stressful society takes on patients: Engineers, office managers, teachers, you name it. Work demands have increased, as has multitasking. Demands outside the workplace add additional stress. Often parents chauffeuring children to multiple activities must also care for aging parents with increasing needs. Electronic devices, always in hand or close by, command our attention (because of work or personal needs), sometimes simultaneously. Finding a moment to catch one’s breath is as difficult as getting enough sleep.

Doctors also see stress mounting in the mirror. We struggle to keep an even keel while facing growing demands above and beyond caring for our patients. Study after study, survey after survey shows that increasing responsibilities – many taking physicians’ time away from personal interaction with patients – are taking away some of the joy in a profession to which we have dedicated our lives and our hearts.

Overcoming ‘Paperwork’ Fatigue

I wouldn’t call it “burnout.” That term suggests giving up or throwing in the towel. It’s more about having the resiliency to meet today’s challenges. Mostly, we’re frustrated and exhausted by administrative and clerical tasks, both in electronic and paper form, pulling us away from our patients. Even ownership of the physician clinical note is tainted by the regulatory burdens related to coding and discrete data documentation for analytics and quality measurements.

The challenge of resiliency needs to be a priority not only for physicians, but the healthcare systems to which they belong. There’s no single cause, but a lot of it is epitomized by the electronic medical record (EMR), particularly among seasoned physicians moving well beyond the paper records they started with at the beginning of their careers.

A December 2016 American Medical Association study starkly spotlighted the problem: for every hour of face-to-face time devoted to patients, physicians spent almost two hours on EMRs and other clerical work. With patient loads jumping and individual patient needs rising, physicians need better tools to maintain their resiliency.

Austin Regional Clinic has recognized the challenge of physician resiliency and is trying to address it on several fronts. For example, we have a team working full-time on optimizing EMR efficiency.  Can we cut the number of computer clicks for each task? Something as simple as ordering a prescription – a task physicians used to do by scribbling a note on a paper pad – can take dozens of clicks while searching through lists of medications, dosages and more.

We’re creating common order sets (called “smart-sets”), preference lists with repetitive orders and medications, and other shortcuts in our EMR to reduce the number of clicks required for common tasks. We also have a team of “specialists” dedicated to meet with physicians onsite at their clinics to help optimize individual EMR workflows and preferences.

EMR vendors have not been able to place the focus needed on improving the user interface, largely due to the burdens of meeting ever-growing regulatory demands for national programs such as Meaningful Use and MACRA (Medicare Access and CHIP Reauthorization Act).  However, the software’s interface with physicians should be improved, and ARC is committed to doing all it can.

Another way to lighten physicians’ clerical loads: scribes who can join physicians during patient visits and assist with EMR documentation, ordering and other electronic clerical tasks in real time. ARC had a successful pilot program and is currently offering scribes to additional physicians who may be interested. We also have advanced practice clinicians, acting as “extenders” to physicians, performing and documenting routine exams such as Medicare wellness check-ups.

Meanwhile, savvy professionals in many fields are turning to mindfulness, meditation and other “me time” activities to reduce stress. They also can and should turn to each other on this issue, viewing it as a mentoring topic. A very effective antidote for decreased resiliency is the professional, day-to-day interaction between physicians, like discussing diagnostic and treatment challenges or the joys of those successes. Time challenges have led to fewer of those interactions. ARC is working on some upcoming formal programs to provide physicians with some of these stress-reducing tools.

Healthcare systems and medical groups should partner with physicians to enhance their resiliency. They have an obligation to do what makes sense to keep physicians enthused and performing at the highest level. The best place to start? Allow physicians to do more of what they do best – heal patients – and less of what others can do – computerized paperwork and administrative tasks.

Manish Naik, MD, is a practicing internist at Austin Regional Clinic (ARC) as well as ARC’s Assistant Chief of Internal Medicine, ARC Chief Medical Information Officer, and ARC’s Electronic Medical Records (EMR) Physician Champion.