Justifiably, much has been written about the personal toll burnout is taking on our physicians, highlighting early retirement, broken relationships, depression and suicide. Also, the organizational impact of burnout, such as decreased productivity, turnover costs and malpractice costs, are well measured and publicized.
The mission statement of most healthcare organizations in some way recognizes their primary obligation to quality and the safety of their patients and communities. In order to fulfill our main purpose - caring for patients - we need to begin looking at this highly prevalent issue from the perspective of those we serve.
Imagine that you are a patient who encounters a burned-out doctor. What impacts might we anticipate on your care?
It has been well documented that physicians who are experiencing at least one major symptom of burnout were more than twice as likely to report a major medical error within the previous 3 months.1 This can be a minor inconvenience, such as forgetting to order a routine blood test, or result in major harm or injury such as a misdiagnosis.
Physicians experiencing burnout are less productive, meaning they may not be able to see as many patients in a day, or may not be able to see their patients as efficiently as they were able to prior to their symptoms. This may mean less appointment access on a given day, or very long waits if the schedule is not adjusted. The tendency of such physicians to cut back their hours, retire early or seek a non-practice position can cause reduced access and vacancies in a practice, which may result in a patient waiting longer for appointments or losing their long-time personal physician prematurely. Further complicating this issue is the AAMC (Association of American Medical Colleges) has predicted that the United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply.2
Our patients know us. They can sense when the doctor is stressed, or disconnected, or apathetic. Most patients are kind and a bit protective. Recent studies have shown that patients are less likely to share information, or reveal troubling symptoms, when they sense their doctor is overwhelmed and burned out.3 Patients do not want to overburden their doctor with more information. However, effective and complete information sharing is critical for physicians to see the entire clinical picture. Having incomplete information is crippling to the ability to make proper diagnoses, or to properly meet the needs of the patient both on the visit and over time.
Finally, from a clinical standpoint, clear information exchange between patients and their physician has an impact on outcomes. A patient who understands their plan of care is more highly engaged and could be more likely to adhere to recommended treatments and medications leading to better health outcomes.4,5
Research shows that burnout is associated with 2-fold increased odds for lower patient satisfaction.6 Healthcare organizations often view patient satisfaction as a survey response indicating likelihood of retention, loyalty, or other consumer-focused measures. Here we refer to something very specific to the patient viewpoint, that is whether they received the empathy, emotional support, and information they needed for their concerns. Patients desire to be cared for, listened to, and responded to in ways that make them feel valued. The impact of burnout on a physicians’ ability to extend themselves for their patients is a major barrier to the patient leaving the encounter with a sense of healing, and a sense of relief from their worry.
Patients should, and I believe they will, be at the forefront of demanding that healthcare organizations prioritize this issue for prevention and management. Healthcare governance should consider the impact on their communities and patients, and realize that at the core, failure to apply resources to impact this issue is an abandonment of their mission.
This article was written with support from Stephanie Sargent, MHA, RN, CPPS.
For more information, feel free to contact Kevin Mosser, M.D. at km@sehqc.com or Stephanie Sargent at sks@sehqc.com.