Moral injury

[anbuitachi]

Posted this on the MD forum, and someone else posted in residency forums and other websites as well. Some of you may have already seen it, but i recommend everyone to watch it since this will involve you when you become doctors!

It's Not Burnout, It's Moral Injury | AMA 15 w/ZDoggMD

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[Lucca]

have seen this circulating. will listen to it and give it a think-over. Reminds me of a piece written some years ago by another physician, although the focus of the piece is somewhat different.

What Middlemarch Can Teach Young Doctors About Burnout - The Atlantic

"Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose."

 

[Matthew9Thirtyfive]

Watched this recently. It was pretty good. I’ve never been offended by the term “burnout,” but I get what he’s saying.

 

[anbuitachi]

thanks for sharing

“And then we meet an electronic health record that is a glorified cash register, with a little patient stuff tacked on”

Boom!

yea i really like that he mentioned that because its so true. its purpose is to maximize billing for the hospital/from insurance.

 

[Matthew9Thirtyfive]

yea i really like that he mentioned that because its so true. its purpose is to maximize billing for the hospital/from insurance.

He has a whole video on how EHR is killed medicine.

 

[907914]

He has a whole video on how EHR is killed medicine.

A single unified EHR, however, designed with the patient in mind is probably the single greatest non-policy based change that I believe could be introduced to the current state of medicine.

 

[Lucca]

A single unified EHR, however, designed with the patient in mind is probably the single greatest non-policy based change that I believe could be introduced to the current state of medicine.

right, the problem is not EHR but EHRs designed for insurance companies as opposed to patients and healthcare workers.

I think it's also worth reading the original article which first stated a lot of the things ZDogg talks about in this video:

Physicians aren't 'burning out.' They're suffering from moral injury - STAT

"In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits."

 

[Matthew9Thirtyfive]

A single unified EHR, however, designed with the patient in mind is probably the single greatest non-policy based change that I believe could be introduced to the current state of medicine.

Not for what he's talking about. We have a single EHR in the military (I think a select few places are trying out Epic or Cerner or something, but the majority of places use AHLTA), and it blows. It also doesn't fix the problem of having to click a bunch of boxes instead of looking and connecting with the patient, which is what he's talking about.

 

[gyngyn]

Not for what he's talking about. We have a single EHR in the military (I think a select few places are trying out Epic or Cerner or something, but the majority of places use AHLTA), and it blows. It also doesn't fix the problem of having to click a bunch of boxes instead of looking and connecting with the patient, which is what he's talking about.

Cerner stinks too.

 

[907914]

Not for what he's talking about. We have a single EHR in the military (I think a select few places are trying out Epic or Cerner or something, but the majority of places use AHLTA), and it blows. It also doesn't fix the problem of having to click a bunch of boxes instead of looking and connecting with the patient, which is what he's talking about.

That is because the military EHR is barely an upgrade of the original EHR systems from the late 80s (at least it was the last I worked on it in 2014).

But I understand the sentiment, everything is designed for the business as opposed to the patient.

 

[Matthew9Thirtyfive]

That is because the military EHR is barely an upgrade of the original EHR systems from the late 80s (at least it was the last I worked on it in 2014).

But I understand the sentiment, everything is designed for the business as opposed to the patient.

That's why it sucks as a platform, not why it takes away from patient interaction. All the EHRs do that. When you have to click boxes and type things into the computer, you aren't looking at the patient. On my ship, we didn't even have it up when the patients were in medical. We'd see them and jot things down on a notebook or note card, then enter the note into the EHR and put the orders in after they left. Not only does it form a better relationship with your patients, but you also pick things up in their body language or just looking at them. Of course, the most we had was 14-15 patients in 2 hours, and it was usually closer to 6-8.

 

[Lucca]

That's why it sucks as a platform, not why it takes away from patient interaction. All the EHRs do that. When you have to click boxes and type things into the computer, you aren't looking at the patient. On my ship, we didn't even have it up when the patients were in medical. We'd see them and jot things down on a notebook or note card, then enter the note into the EHR and put the orders in after they left. Not only does it form a better relationship with your patients, but you also pick things up in their body language or just looking at them. Of course, the most we had was 14-15 patients in 2 hours, and it was usually closer to 6-8.

That’s also not necessarily a problem with the EHR tho. If every physician had a scribe and never looked at the EHR, then the problem you described would be eliminated. The deeper problem is what the EHR is used for, imo, than how you use it which is just a surface level problem although that is also an important one.

 

[Matthew9Thirtyfive]

That’s also not necessarily a problem with the EHR tho. If every physician had a scribe and never looked at the EHR, then the problem you described would be eliminated. The deeper problem is what the EHR is used for, imo, than how you use it which is just a surface level problem although that is also an important one.

Right, of course. But not every place has or can afford them.

 

[907914]

That's why it sucks as a platform, not why it takes away from patient interaction. All the EHRs do that. When you have to click boxes and type things into the computer, you aren't looking at the patient. On my ship, we didn't even have it up when the patients were in medical. We'd see them and jot things down on a notebook or note card, then enter the note into the EHR and put the orders in after they left. Not only does it form a better relationship with your patients, but you also pick things up in their body language or just looking at them. Of course, the most we had was 14-15 patients in 2 hours, and it was usually closer to 6-8.

And that also works in a military settin

Right, of course. But not every place has or can afford them.

every place would be able to afford scribes if you didn’t have to worry about billing staff.

 

[Matthew9Thirtyfive]

And that also works in a military settin

every place would be able to afford scribes if you didn’t have to worry about billing staff.

Or paying superfluous administrators and clipboard warriors.

 

[Matthew9Thirtyfive]

And that also works in a military settin

It works in a civilian setting too. I know doctors who do it. It takes more time for them, but they feel it results in better care. I know at least some of their patients appreciate having their doc look at them and pay attention to them instead of typing away.

 

[907914]

It works in a civilian setting too. I know doctors who do it. It takes more time for them, but they feel it results in better care. I know at least some of their patients appreciate having their doc look at them and pay attention to them instead of typing away.

Ignore that part, it was an incomplete thought that I didn’t realize I hadn’t already deleted. Apologies.

 

[907914]

Or paying superfluous administrators and clipboard warriors.

I feel like this is one of the major reasons why ‘home visits’ are coming back with force. Doctors are fed up with the business and just want to practice medicine. Thus, we have physicians in increasing number forgoing a clinic and just charging $200 a month to visit a patient in the patient’s home for physicals, wellness visits, prescriptions and referrals.

House Call Medicine Makes a Comeback

 

[Matthew9Thirtyfive]

I feel like this is one of the major reasons why ‘home visits’ are coming back with force. Doctors are fed up with the business and just want to practice medicine. Thus, we have physicians in increasing number forgoing a clinic and just charging $200 a month to visit a patient in the patient’s home for physicals, wellness visits, prescriptions and referrals.

House Call Medicine Makes a Comeback

This is my dream when I get out of the .mil.

 

[907914]

This is my dream when I get out of the .mil.

I would like to do something like this as well. Dual board in EM/IM. Home visits 2 weeks a month, practice international/austere medicine on a volunteer basis the other 2. Maybe throw in some teaching, medical director of National Park/National Forest area, volunteer EMS director, and a month or two a year of expedition medicine.

Any combination of the above would be satisfying for the non-clinic seeking physician.

If you have never heard of it: https://www.google.com/amp/s/amp.th.../expedition-medicine-save-lives-and-go-places

 

[anbuitachi]

And that also works in a military settin

every place would be able to afford scribes if you didn’t have to worry about billing staff.

That will get expensive to hire high quality scribes. Otherwise you'll need to worry about lawsuits and how well their documentation defends against them

 

[Med Ed]

Dual board in EM/IM.

The thought of maintaining two board certifications just sent chills down my spine.

 

[Angus Avagadro]

I think Z Dog briefly touched the etiology of the moral injury. I posted in a similar thread that our physician parents and grandparents took call every 2nd or 3rd night during residency. We have greatly limited hours compared to then, 80 hours a week, yet physician suicide rises. I don't believe this is from a lazy generation, far from it. I believe medicine and physicians are no longer valued the way they were. We can hire a new grad cheaper, we can get a midlevel to do the same thing, cheaper, we can make them fill out paperwork for 1-2 hours each evening without compensation because where are they going to go? They will have to sell their house and move their kids.
Physicians are no longer valued for excellent practice. Their value is only throughput, hitting their RVU mark, and charting correctly so the coders can get the bill in quicker. Physicians are having their compensation reduced if their patients have elevated A1C levels or don't meet anticoagulation guidelines. That's right, reduced pay if your patient is non compliant. One of the things that irritates me is you are being directed by someone half your age who is not your intellectual peer and knows nothing about running a medical office.Things will get worse before they improve, if at all. We need a rebellion in organized medicine as our leadership has been bought and paid for.

 

[Matthew9Thirtyfive]

I think Z Dog briefly touched the etiology of the moral injury. I posted in a similar thread that our physician parents and grandparents took call every 2nd or 3rd night during residency. We have greatly limited hours compared to then, 80 hours a week, yet physician suicide rises. I don't believe this is from a lazy generation, far from it. I believe medicine and physicians are no longer valued the way they were. We can hire a new grad cheaper, we can get a midlevel to do the same thing, cheaper, we can make them fill out paperwork for 1-2 hours each evening without compensation because where are they going to go? They will have to sell their house and move their kids.
Physicians are no longer valued for excellent practice. Their value is only throughput, hitting their RVU mark, and charting correctly so the coders can get the bill in quicker. Physicians are having their compensation reduced if their patients have elevated A1C levels or don't meet anticoagulation guidelines. That's right, reduced pay if your patient is non compliant. One of the things that irritates me is you are being directed by someone half your age who is not your intellectual peer and knows nothing about running a medical office.Things will get worse before they improve, if at all. We need a rebellion in organized medicine as our leadership has been bought and paid for.

I wonder what would happen if a critical mass of docs went to direct care.

 

[907914]

I wonder what would happen if a critical mass of docs went to direct care.

Hopefully a massive loss of revenue for insurance companies, followed by bankruptcies and massive layoffs of insurance companies, billing departments and admin staff, followed by a decade of turmoil eventually leading to universal Medicare/single payer healthcare.

 

[Matthew9Thirtyfive]

Hopefully a massive loss of revenue for insurance companies, followed by bankruptcies and massive layoffs of insurance companies, billing departments and admin staff, followed by a decade of turmoil eventually leading to universal Medicare/single payer healthcare.

Yeah that’s the idea. It was more of a rhetorical question.

 

[907914]

Yeah that’s the idea. It was more of a rhetorical question.

No question is a rhetorical question if someone is willing to answer it.

 

[Matthew9Thirtyfive]

No question is a rhetorical question if someone is willing to answer it.

Lol I just meant that I didn’t need an answer because I know the answer and was just making the point by asking the question.

 

[907914]

Lol I just meant that I didn’t need an answer because I know the answer and was just making the point by asking the question.

I know, I just need a reason to reply as a distraction from studying for a Micro practical I have in 30 minutes lol

 

[ginsengreset]

Hopefully a massive loss of revenue for insurance companies, followed by bankruptcies and massive layoffs of insurance companies, billing departments and admin staff, followed by a decade of turmoil eventually leading to universal Medicare/single payer healthcare.

@atomi would like to have a word with you

 

[de Ribas]

@atomi would like to have a word with you

Account removed I guess