Burn out

Robert Bell rmsbell200 at YAHOO.COM
Sun Feb 7 19:59:34 UTC 2016


Talking to a very hard working nephrologist this week and we both agreed that good caring relationships with patients was a buffer to burn out. e.g. the doctor who calls patients when concerned, to make sure they are doing well.

Have not read anything that confirms that impression, but it seems very possible.

Rob Bell

Sent from my iPad

On Feb 3, 2016, at 11:38 AM, James Navin<0000000581520482-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:

> Many forget the rule for what we do---Do the right thing for the right reasons and do it that way every time!!!
>  
> Many forget this as money gets involved
>  
> jn
>  
>  
> -----Original Message-----
> From: Regan, Elizabeth <ReganE at NJHEALTH.ORG>
> To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Sent: Tue, Feb 2, 2016 10:25 am
> Subject: Re: [IMPROVEDX] Burn out
> 
> Dear Ji,
> I agree with you enthusiastically on your focus.  Our job as physicians is to do the right thing and care for illness/patients.  I would argue that there is some relationship to burn-out when we no longer feel good about the work we are doing.  Short-cutting care for cost reasons feels crummy to me and I have long resisted it.  I love finding the right diagnosis after carefully sorting through the symptoms and possibilities.  It is so satisfying that it brings me back to the clinic happily.
> Liz
> 
> From: "Baang, Ji Hoon" <JiHoon.Baang at TUHS.TEMPLE.EDU>
> Reply-To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Baang, Ji Hoon" <JiHoon.Baang at TUHS.TEMPLE.EDU>
> Date: Tuesday, February 2, 2016 at 1:11 AM
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] Burn out
> 
> My little contribution in changing the culture when I round with my residents and students is that I tell them to ignore the administrators. I tell them to focus on taking care of your patients, learning medicine and being a good doctor. Write notes to communicate and tell people what you are thinking. If a patient wants to stay because she/he just wants to stay for 1 more night because it is cold and rainy outside, I tell them to let the patient stay. And at the end of rounds, I ask our team, “So how do you think we did with our length of stay? Our readmission rate? Our patient satisfaction score?” And more often than not, we end up doing a decent job and make our administrators happy. And most importantly, we all have fun taking care of our patients. 
> 
> After my training, I worked in industry for a few years. I learned a little bit about the business literature. I think what we are seeing in medicine closely resemble what pharma did in the 1980s. Emphasizing metrics and profit to the extent that it is changing our culture. Pharma used to be a well respected business until sales and marketing became the main driver of its business. And we all know what happened. The most successful and sustainable businesses really focus on what is really important. The customer, and in our case the patient. Metrics are their for our patients and not for profit. And so if you focus on the patient, the metrics often fall into place. For example, if you have a patient in front of you and you know the diagnosis on day 1, your length of stay will not be long. It is often the patient with no diagnosis and no plan that tends to stay for many days and weeks. 
> 
> I think a lot of the burnout issue comes from the simple fact that people are just not having fun, because they are focusing on issues that they don’t really care about. I know I am oversimplifying a complex problem but even complex problems have a root cause. In this case, I think the root cause is that many are not able to find meaning in the work that they do anymore. 
> 
> I’ll end with a quote from a business man that I think is relevant to what is happening in medicine today:
> 
> We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.      - George Merck
> 
> Ji
> 
> Ji Hoon Baang, M.D.
> Assistant Professor of Clinical Medicine
> Internal Medicine Subinternship Director
> The Lewis Katz  School of Medicine at Temple University
> Philadelphia, PA
> (T) 215-707-1622
> (F) 215-707-0943
> 
> 
> On Feb 1, 2016, at 3:35 PM, Vic Nicholls <nichollsvi2 at GMAIL.COM> wrote:
> 
> Mr. Maude,
> 
> When hospitals motto appears to be #profitoverpatients, I don't think they will care about the workerbee doctors. Its pretty obvious they don't, unless it is to keep the money rolling in to pay for admin salaries.
> 
> Vic
> 
> 
> On 2/1/2016 6:17 AM, Jason Maude wrote:
> Alan
> This is very depressing. Are you seeing any impact from the IOM report yet in helping to change culture? I am expecting/hoping that the report will start being discussed by hospital boards and this will eventually translate in some sort of action which could include providing and encouraging the use of decision support as you describe.
> Regards
> Jason
> 
>   Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com  <http://www.isabelhealthcare.com/>
> 
> 
> 
> 
> 
> 
> 
> On 30/01/2016 16:30, "Alan Morris"<Alan.Morris at IMAIL.ORG>  wrote:
> 
> Thanks - this is likely to continue until we, as a profession, focus on
> the core problem:  the overtasked physician, asked to do humanly
> impossible decisions without effective decision support.  I believe we
> will be mired in this problem set unless we target automatic control of
> medical tasks (closed loop protocols) with adequately detailed computer
> protocols.  This requires a cultural change and recognition that the
> Hippocratic model (the expert model) is necessary but by itself
> insufficient.  Most of the time I feel as if I am talking to a wall.
> Have a nice day and Happy New Year.
> Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
> 
> Medical Director, Urban Central Region Pulmonary Function Laboratories
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
> 
> Office Phone: 801-507-4603<tel:801-507-4603>
> Mobile Phone: 801-718-1283<tel:801-718-1283>
> 
> 
> 
> 
> 
> 
> On 1/30/16, 08:57, "Robert Bell"
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>  wrote:
> 
> The AMA Morning Rounds today has an excellent article on Physician
> burnout. It mentions Errore in Medicine.
> 
> Rob Bell, M.D.
> 
> 
> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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