Moral injury

[SurfingDoctor]

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Sure, that does sound like an individual solution, which seems appropriate. I will agree that at the residency level most problem residents (unless the whole residency class is miserable) may benefit from individual solutions. I think the discussion points being made (unwieldiness of EMR, insurance/pre-auth requirements, documentation minimums for billing, etc.) likely affect attendings more so than residents, albeit likely field specific - for example, covering an inpatient service for a surgeon means you deal with patient care (good) and EMR documentation (may require certain amount of PE or ROS checkboxes to get paid), but not insurance authorization for the surgeries, figuring out billing requirements, etc.)

However, FM residents that I know have to do pre-auths and insurance appeals for their own stable of outpatients, have to place initial billing codes which are signed off by the attending (and thus need to know what needs to be included in the note to bill at what level), need to know quality of care (MIPS?) criteria mentioned in their own notes to ensure their patients are being screened appropriately. I'm not saying that all of this inevitably leads to burnout for every single FM resident - however, I can't imagine doing pre-auths is fun or stimulating for doctors who primarily want to treat patients, and is an impediment to patient care. I get why they are necessary, but these are the systematic issues that can be fixed. Having an insurance not cover a life-improving (even life-saving sometimes) medication despite pre-authorization application is an impediment to patient care.

That's not to say there is an easy solution to all of this, because it all comes down to the cost of healthcare. But I believe the video was taking the first step of trying to get people to define what the problem is, on a systematic level. First step to fixing a problem is to admit there is one.

“Nobody knew healthcare could be so complicated”

 

[VA Hopeful Dr]

Sure, that does sound like an individual solution, which seems appropriate. I will agree that at the residency level most problem residents (unless the whole residency class is miserable) may benefit from individual solutions. I think the discussion points being made (unwieldiness of EMR, insurance/pre-auth requirements, documentation minimums for billing, etc.) likely affect attendings more so than residents, albeit likely field specific - for example, covering an inpatient service for a surgeon means you deal with patient care (good) and EMR documentation (may require certain amount of PE or ROS checkboxes to get paid), but not insurance authorization for the surgeries, figuring out billing requirements, etc.)

However, FM residents that I know have to do pre-auths and insurance appeals for their own stable of outpatients, have to place initial billing codes which are signed off by the attending (and thus need to know what needs to be included in the note to bill at what level), need to know quality of care (MIPS?) criteria mentioned in their own notes to ensure their patients are being screened appropriately. I'm not saying that all of this inevitably leads to burnout for every single FM resident - however, I can't imagine doing pre-auths is fun or stimulating for doctors who primarily want to treat patients, and is an impediment to patient care. I get why they are necessary, but these are the systematic issues that can be fixed. Having an insurance not cover a life-improving (even life-saving sometimes) medication despite pre-authorization application is an impediment to patient care.

That's not to say there is an easy solution to all of this, because it all comes down to the cost of healthcare. But I believe the video was taking the first step of trying to get people to define what the problem is, on a systematic level. First step to fixing a problem is to admit there is one.

After residency, if you're doing your own pre-auths and insurance appeals you're doing it wrong.

 

[Foot Fetish]

I burned out this year, just past the halfway point of M3. I was on a rotation that had me working 13-hour night shifts in the dead of winter, which destroyed my circadian rhythms. There was a point where I didn't see daylight or my partner for a week. On top of this, several of the attendings were jerks, and as someone who suffers from some baseline social anxiety, this created a miserable, shell-shock like state for me. Add to this the never-ending onslaught of research deadlines, assignments, meetings, e-mails, and all the other hell that comes with being a cog in this machine. The cherry on top was a string of life tragedies that befell my family around that time.

I used to be the student who, in my preclinical years, spent 12 hours per day in the library. Now it's a success if I can just get out of bed in the morning without having a mental breakdown.

Medical school has been an incredible journey, but I constantly worry about the toll it is taking on my mind, body, and soul. To be brutally honest, I probably would not have done it all over again. Don't get me wrong, I love the science of medicine and helping patients...but some days I question if i wouldn't have been much happier as a pharmacist or something.

 

[deleted87051]

I burned out this year, just past the halfway point of M3. I was on a rotation that had me working 13-hour night shifts in the dead of winter, which destroyed my circadian rhythms. There was a point where I didn't see daylight or my partner for a week. On top of this, several of the attendings were jerks, and as someone who suffers from some baseline social anxiety, this created a miserable, shell-shock like state for me. Add to this the never-ending onslaught of research deadlines, assignments, meetings, e-mails, and all the other hell that comes with being a cog in this machine. The cherry on top was a string of life tragedies that befell my family around that time.

I used to be the student who, in my preclinical years, spent 12 hours per day in the library. Now it's a success if I can just get out of bed in the morning without having a mental breakdown.

Medical school has been an incredible journey, but I constantly worry about the toll it is taking on my mind, body, and soul. To be brutally honest, I probably would not have done it all over again. Don't get me wrong, I love the science of medicine and helping patients...but some days I question if i wouldn't have been much happier as a pharmacist or something.

3rd year is a huge adjustment for many. It’s very disorienting to be on a new service every few weeks and people can be jerks. Once you become accustomed to the workplace and get to know people, things do improve. For me, the hospital feels as much like home as my house. Pick a field that calls to you. It can really be great. During the winter months I usually don’t see daylight either, I go to work when it’s dark and get out when it’s dark. It has become no big deal. I just imagine I’m one of those happy Danes.

 

[Neopolymath]

I burned out this year, just past the halfway point of M3. I was on a rotation that had me working 13-hour night shifts in the dead of winter, which destroyed my circadian rhythms. There was a point where I didn't see daylight or my partner for a week. On top of this, several of the attendings were jerks, and as someone who suffers from some baseline social anxiety, this created a miserable, shell-shock like state for me. Add to this the never-ending onslaught of research deadlines, assignments, meetings, e-mails, and all the other hell that comes with being a cog in this machine. The cherry on top was a string of life tragedies that befell my family around that time.

I used to be the student who, in my preclinical years, spent 12 hours per day in the library. Now it's a success if I can just get out of bed in the morning without having a mental breakdown.

Medical school has been an incredible journey, but I constantly worry about the toll it is taking on my mind, body, and soul. To be brutally honest, I probably would not have done it all over again. Don't get me wrong, I love the science of medicine and helping patients...but some days I question if i wouldn't have been much happier as a pharmacist or something.

Consider purchasing a light designed to reduce this feeling.

 

[SurfingDoctor]

Seemed apt...

There’s a mental health crisis among doctors

Depression among doctors is more common than we may think, and it starts in medical school, says primary care physician Elisabeth Poorman. Dr. Poorman joined THINK to talk about the “cloud of silence” around mental illness in medicine and how it’s a byproduct of a dysfunctional healthcare system.

www.nbcnews.com

 

[DrDarce]

I was forced to watch this during a mandatory "wellness" meeting that took up an entire afternoon. So I hate the video.