As a primary care physician, I saw firsthand that the patient experience was not always optimal. Patients were often frustrated by miscommunication or by inefficiencies in the system. And they weren’t always given the respect and focused attention they deserved.
As for me, I burned out trying to provide compassionate care in the system as it was in the 1990s. I chose to leave after just three years of practice. In my second career, as a freelance health care writer, I have come to understand some of the large-scale factors that undermine an ideal care experience, such as a less-than-ideal organizational culture and traditional hierarchies that hinder open communication.
I’ve also come to appreciate that the quality of the patient experience is hugely dependent on the condition of the interface with the care provider. An optimal patient experience requires that both patient and care provider are able to show up at their best—the patient is informed, activated, and engaged and the care provider is empathetic, communicative, and respectful. For the provider half of that dyad to be fully present for that connection, he or she must be well.
And yet almost half of physicians have one or more symptoms of burnout. Burnout is a tragedy for providers who walk away from their chosen profession, for those who remain yet work at diminished potential, and most of all for patients. How can I show up to listen, to be present, to offer the best of myself as a clinician when I’m stressed to my limits as a human being? This isn’t the kind of professional life clinicians want and it’s not conducive to the kind of experience patients deserve.
What’s the solution? Providers can take steps to care for themselves, like meditation and practicing mindfulness. But no degree of self-care will completely inoculate providers from burnout in a system that fails to recognize the humanity of both patients and caregivers. Fortunately, researchers have identified specific factors in the practice environment that predispose to burnout, such as time pressure, lack of control regarding work, and insufficient resources.
Payment reform offers a unique opportunity to address these factors. As doctors and hospitals are increasingly paid to provide better care rather than doing more procedures and ordering more tests, there will be a greater incentive to invest in systemic changes to support better outcomes.
Done right, these changes can reduce burnout. For example, hospital executives can negotiate with payers to pay for important services, such as e-visits, that put extra strain on providers because these items are rarely covered under the fee-for-service payment structure. Leaders of physician group practices can hire additional clinicians to reduce to each provider’s patient panel to a reasonable size. They can support part-time positions and job sharing, allowing care providers with young children or elderly parents to scale back when needed. These steps will require an upfront investment, but will reap large dividends for both providers and patients.
To improve the patient experience, we must respect the humanity of those providing care. As a primary care physician said to me recently, "If we want caregivers to give, we must first care for the caregivers.” Common sense? Yes, yet a relatively unchartered area that offers a valuable opportunity to accelerate improvement and ensure that every patient receives the kind of care that we all want: care that is high-quality, safe, and compassionate.
Diane W. Shannon, MD, MPH is a freelance writer who focuses on improvement in health care. She lives in Massachusetts.