More on Burnout.

Paul Treder twobikerz at ICLOUD.COM
Tue Jul 23 17:48:52 UTC 2019


Thank you, too, Dr Bell, for posting my thoughts.  I agree that a great place to start to improve the quality and accuracy of data gathering is with EMR’s.  None that I have seen are very “user friendly” for the purposes under consideration.  More clinician input into the design and functionality would be highly desirable. 

I can see a role within SIDM to evaluate “test” accuracy and reliability, in particular those used so commonly as proxy measures to determine quality of care.  Examples are HgbA1c as a proxy for quality of diabetes care and LDL-c as a proxy for quality of heart attack prevention.  In my opinion, we really need to determine if these are the correct indicators for quality of care in management of the particular problem, or of prevention.  

And yes, our clinicians experiencing burnout issues, especially those who are not in an position to retire or redirect their careers, need support, understanding, and kindness. 

Best regards,

Paul F Treder, APNP (retired)



Sent from my iPhone

> On Jul 22, 2019, at 4:39 PM, ROBERT M BELL <rmsbell200 at yahoo.com> wrote:
> 
> Great, great comments Paul,
> 
> i have for many years on this list been being trying to get attention to the diagnostic tests that we use to help with our diagnoses. 
> 
> And now we can add in the study criteria themselves that we use to obtain , what we think, are meaningful results. 
> 
> The variance in many tests is small and in many cases large.
> 
> If this is the case would it not be better to triage all the “tests” we use and work on those so that accuracy is enhanced, perhaps even before we consider such things as biases.
> 
> I hear for members on this list that with radiological “tests” there is already a great emphasis on making improvements.
> 
> In this scheme of things would it be better to identify what we think should be worked upon (particularly the EMRs) so that slowly, slowly we get better data.
> 
> Should the “tests and study parameters” we use be a major responsibility of  SIDM?
> 
> But do not forget that our colleagues are often lost/hidden in all of this - they need our help and should also NOT be forgotten. I do not have a lot of experience with burn out but suspect it is a little like PTSD that needs a lot of kindness, help, and support from many.
> 
> Thank you Paul.
> 
> Rob Bell, M.D.
> 
>> On Jul 22, 2019, at 9:05 AM, Paul Treder <twobikerz at icloud.com> wrote:
>> 
>> Kind of an interesting article, and perhaps the next 2 installments will touch on my perspective.  Metrics to help measure the “quality of care” are all well and good, if they are the correct metrics.  Several are only “proxies”, and with further research, could be found to not be as meaningful as once thought.  And the data are only as good as the information collected.   From my personal experience in a large health care system, much of the data was flawed, and my “scores” for the metrics of colon cancer and breast cancer screening, and of pneumonia vaccination in vulnerable populations, were highly inaccurate, and much lower than reality.  There were several reasons for this, the most common of which were these: cumbersome methods of data entry into the EMR’s in use by the health system (3 different EMR’s in 12 years);  staff not given adequate time to do data entry; relying on claims data rather chart review; attributing patients to my panel whom I had never seen, or, the patients had moved on to someone else in another group or to another health system and were not deleted from my panel at the time of data collection and reporting.   And when these issues were brought to the attention of management, they essentially shrugged it off. 
>> 
>> Perhaps the bigger issue I have with Dr. Pearl is that he says nothing (so far) about the role of the patient in following through with recommendations made to patients for screening; and treatment plans, especially for those with chronic illness such as Diabetes.  There really is only so much a clinician can do, and the rest is up to the patient and their family.
>> 
>> Finally, using certain metrics as measures of quality of care, can have a detrimental effect, especially when tied to Pay 4 Performance (P4P).   Some clinicians will only take “easy” or uncomplicated patients to achieve and maintain high scores on their metrics. Are they really better than the clinicians who are willing to have on their panels the complex and difficult patients, who might not be able to get their HGB below 8, or cholesterols into “normal ranges” (as two common examples)?   Over the years, a clinician can grow weary of these bureaucratic games to the point of not looking forward to going in to clinic, and sometimes even dreading it.  All this, in my case,  were significant sources of clinician “burn out”, and eventually, reaching the decision to retire. 
>> 
>> And how does that correlate to contributing to diagnostic error?   Mental and physical weariness and fatigue.  Years of 12 to 14 hour days, much of that time devoted to thorough documentation, rather than caring for the patient, or having a life outside of clinic responsibilities, take their toll.  
>> 
>> Sent from my iPad
>> 
>>> On Jul 21, 2019, at 6:01 PM, ROBERT M BELL <0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
>>> 
>>> https://www.forbes.com/sites/robertpearl/2019/07/08/physician-burnout-1/amp/
>>> 
>>> 
>>> 
>>> 
>>> 
>>> 
>>> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine
>>> 
>>> To unsubscribe from the IMPROVEDX list, click the following link:<br>
>>> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
>>> </p>
>> 
> 






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine




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