
‘Alarming’ burnout is making doctors want to kill themselves - spking
https://nypost.com/2019/01/16/alarming-burnout-is-making-doctors-want-to-kill-themselves/
======
jseliger
One painful thing is that most people entering med school don't viscerally
understand how long, painful, and expensive the process is, or how much better
some of the alternatives can be: [https://jakeseliger.com/2012/10/20/why-you-
should-become-a-n...](https://jakeseliger.com/2012/10/20/why-you-should-
become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-
perils-of-medical-school)

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eldavido
It is a well-known fact that the entire industry under-invests in tech
infrastructure. Congress literally _paid_ them to do it using "meaningful use"
incentives as part of the ACA, and still can't get them to invest more. Ask
yourself who has better front-office CRM: your local car dealership or your
doctor?

Do you think the audo dealership does it because they like spending money? No,
it's because they compete and are paid based on quality of customer service,
and believe (rightly) that keeping good customer records is an important part
of that.

No such incentives exist in the medical industry. Everything is just "how many
procedures can you do per hour". Since the industry doesn't encourage good
record-keeping, it's seen as a "chore" doctors don't like doing and hence hate
doing it, and try to do it as quickly as possible, before they can get back to
"making money" doing hip and knee surgery, seeing more patients, etc.

The solution is really pretty simple: there needs to be meaningful competition
on the (patient-perceived) quality of care. Our current insurance-driven
system doesn't promote that at all. Handing customers cash, whether from
employers, the government, whoever, and letting them spend it, gets the
incentives a lot closer to right.

~~~
aeternus
Patient-perceived quality of care isn't the right measure. Patients don't like
being told that they need to exercise, lose weight, drink less alcohol, rest.

A large part of a patient-perceived score is whether they get what they want.
This often isn't in the best interest of the patient. With patient-score
focused medicine, you get over-prescription of pain-meds, adderall,
antibiotics. You also incentivize doctors _not_ to challenge patients with
dangerous views like anti-vax.

~~~
eldavido
That's perhaps true in some cases. But I think patients need to have a little
more skin in the game.

Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery
(he "only" gets about 10% of the charged amount). If there was even a 10%
copay on this, possibly means-tested if you want to make it fair for poor
people (meaning it goes up the more income/wealth you have), you'd better
believe more people would choose dietetics (my mom's profession, group classes
cost like $10 each) over $30K knee replacements.

You're talking about a procedure that costs roughly the _yearly_ pretax median
income of a US adult. Some people have multiple of these per life. We can play
the "who pays" game all day, pushing the cost of care around on the plate, as
it were, but until we stop prescribing high-cost surgeries and expensive
solutions to chronic conditions, the needle isn't going to move on how much we
spend on health. 20% of GDP and growing, to be exact.

I just don't think there's a way around this without forcing patients to feel
a bit more pain.

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anujsharmax
> "Because the majority of doctors are overworked, exhausted, and discontent,
> they've normalized their misery and pretend that it's not as bad as it
> seems"

This quote from the study hit me.

So many people are unhappy with the amount of unproductive work they do (e.g.
administration work for doctors). But no one wants to change it?

~~~
britch
If you haven't read "Why Doctors Hate Their Computers" [0] I highly recommend
it. It relates exactly to what you're talking about (in terms of boring admin
work) and applies to more than just doctors.

My takeaway was that while doctors hate the very structured process and
busywork, the hospital admins think it is better for the patient and better
for the institution.

In some ways it makes sense. It's hard to refine and make a process consistent
when every doctor does things different or doesn't properly record everything.
On the other hand it removes a lot of agency from the doctors and leaves them
unfulfilled.

It's mass production principles applied to "knowledge" work.

There was a time when one person would make a whole chair. I imagine it was at
least somewhat fulfilling to transform a bunch of wood into a functional
object.

As time went on it became clear that it was more efficient to break it into
component parts, blah blah blah, assembly line. After the assembly line (but
before automation) there were a lot of people "making" chairs, but I'm sure
the guy fixing the right arm in place didn't feel as fulfilled as the original
craftsperson.

We're getting that to some degree in hospitals now. Hospital admins want the
ability to tinker with procedure, to know what's going on in a real, measured
way and maximize efficiency. It just so happens that it leaves the doctors a
whole hell of a lot less fulfilled.

[0] [https://www.newyorker.com/magazine/2018/11/12/why-doctors-
ha...](https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-
computers)

------
lelima
"Most doctors say it’s the level of paperwork and data input they’ve had to do
since medical records went digital".

So before "digital" they didn't fill in as many records?

Checking the main article [https://www.medscape.com/slideshow/2019-lifestyle-
burnout-de...](https://www.medscape.com/slideshow/2019-lifestyle-burnout-
depression-6011056?faf=1#5) found:

"All that paperwork sucks all of the enjoyment out of being a doctor." -Family
physician

"Fear of litigation, bad reviews, and complaints make everything worse."
-Dermatologist

I can change the doctor words for any other profession and still found that
any profession can argue the same thing

"All that paperwork sucks all of the enjoyment out of being a teacher / lawyer
/ policeman." -Family teacher / lawyer / policeman

but being the most common reason (paperwork) and want to kill themselves?

~~~
jraines
I can't / won't argue the point in detail for every profession, but would
wager from personal observation that what doctors have experienced with EMR
systems is immensely worse. There might be some good systems out there but
what I've seen is a Kafka-esque UX nightmare that the doctors can't say "no
thanks" to unless they own their own practice, which is being made harder in
part because of all the red tape (digital & otherwise)

~~~
0xdeadbeefbabe
Here's the article on why doctor's hate their computers
[https://news.ycombinator.com/item?id=18381969](https://news.ycombinator.com/item?id=18381969).
It's a UX nightmare or revenge on the ancillaries.

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mdmnk
> Nazario says that while burnout is common among workers, for doctors, it can
> seem worse because all the schooling and training they’ve undergone can feel
> like a waste when most of their day is spent typing codes into their medical
> software.

> “It’s almost like being a cog in a wheel, where they’re going through the
> motions of what’s necessary, not necessarily using all the knowledge that
> she or he has gained in the years of training,” Nazario says.

Sounds a whole lot like software engineering. I am guessing that this is how
many people with specialized skill sets feel once they've maintained a job
utilizing that skill set for some length of time.

~~~
jseliger
Software engineering has nothing like the licensing and education requirements
medicine does. You do not have to spend seven post-grad years to become a
software engineer, or take out four years of post-grad loans.

~~~
eldavido
And yet, software (as an industry) mostly works.

Something to consider.

~~~
sixstringtheory
What I’m seeing is that you’d be fine to let someone who got disillusioned
with the career/salary prospects of holding a useless degree take a 2 month
course on the Paleo diet, and then remove one of your kidneys.

~~~
eldavido
Here's what would happen in reality:

Doctors need insurance against medical malpractice and other forms of
liability. So the insurance companies would develop their own form of
standardization/credentialing, much like what happens in other industries like
construction or shipping, to determine what are actually the highest risk
factors for liability and other losses. You wouldn't be able to get insurance
without following these guidelines.

The advantage of this system is that it's not written into law, making it
much, much easier for it to change and evolve over time. Insurers would
compete for business by pushing up against the minimum allowable standards and
innovation would occur.

The thing I think people forget, is that legislated mandates are by their very
nature, extremely hard to change. Regulations of the sort the FCC uses are
easier, as they can be done by the agency itself, but they have their own
problems.

I just don't think it requires MD-level training to do everything we need
doctors to do today. Nurse practitioners and other less-credentialed peers are
already taking up a lot of workload in medical offices and costs are still
exploding.

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woodandsteel
I have a rule that whenever we have a problem or controversy in the US, one of
the things we should do is look at what the situation is in other countries,
and in particular see if they are doing things better there.

With that in mind, what is physician morale like in other countries,
especially Western European ones? And if it is, as I suspect, significantly
better, then what is the reason?

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avgDev
I have a friend who is a doctor pharmacist. Every time we meet I feel
genuinely bad for her. She works 12 hour days, in what basically is retail.
She is required to push vaccinations and meet quotas. Stands all day, can't
step out for lunch. It gets insanely repetitive.

Honestly, I would not be able to do it.

I was on friendly terms with my primary physician and he was also miserable.
Insurance kept fighting his decisions to save money. He was getting pushed to
see more patients and become more efficient. He often told me he is not happy
in medicine and was jealous of me getting a CS degree and considered it
himself, but felt too old.

I've had health issues over the years and only met one passionate doctor in
Palo Alto, that was wealthy enough to pursue whatever he wanted in medicine.

However, I feel as we push for more efficiency people everywhere will have a
lower satisfaction and higher burnout. They may initially be excited to work
harder for higher pay but eventually they will realize they miss being able to
have a slower day and chat with other people.

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0xdeadbeefbabe
Are there any rogue doctors who don't fill out paperwork?

~~~
bawana
All of us using EMRs don't fill out paperwork anymore. We just copy-paste.
Unfortunately admins think you can quantify stuff by making more measurements.
But that's so amusing if you just talk to a few patients. It's like trying to
quantify the quality of poetry.There is a HUGE gap between the patient's
experience and the actual disease. That's why our ERs are clogged with people
who think they are sick. Getting through that thick layer of emotion and still
communicating with the patient is hard work.And it often fails. It's like the
policeman who comes to the scene of an accident and tries to get the story of
what happened from the accident victim (if she/he can even talk). Even if the
victim is capable of speaking, the emotional turmoil renders the story moot.
And amid all this chaos, they expect us to make cost effective diagnostic
decisions? where one slip up can lead to an error of omission or an error of
commission? and then a law suit? And if you are an employed physician, there
is a bean counter looking to make you word harder. Even if you are part of a
private group practice, the old guys take a cut of your money while you sweat,
cry and bleed.

