Wednesday, October 2, 2013

Doctors Look For A Way Off The Medical Hamster Wheel

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”


Dr. Julie GriffinCMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

In Search of Balance by Richard Swenson, MD
Practical Practice Issues in Today’s Christian Doctor


  1. CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an "enduring calm" in calamity—these are expectations of physicians."

    Dr. Griffin rightly referenced Dr. Richard Swenson's book "Margin" - a must-read in our currently mathmatically dysfunctional work environment (ICD-10 with 170,000 elements).
    Dr. Griffin also included "enduring calm" as an expectation of physicians.
    Dr. Swenson addresses this physician attribute directly in his new book "Contentment - The Secret to a Lasting Calm" - another must-read from the CMDA library.

  2. Oops, prior comment referred to Dr. Swenson's book "Margin", should have referred to "In Search of Balance". No harm, "Margin" is an equally deserving "must-read".