We must prioritize clinician-patient relationships to create the best environment for healing.
At its heart, health care is about people taking care of one another. It’s an intimate practice rooted in some of our best qualities as humans. People who choose healing professions understand this and commit themselves to years of training, so they are prepared to help relieve the suffering of others.
But in a system that demands high productivity and imposes excessive administrative burdens, clinicians find it increasingly difficult to provide the care their patients need. The industrialization of health care has corrupted the healing relationship. Health care has become more transactional, less personal. Too often, our system not only fails to heal, but creates new suffering.
We must restore the art of healing to its rightful place at the center of our health system. That means providing adequate time for clinicians to listen and talk to patients, reducing administrative burdens, and liberating clinicians from business concerns that draw their focus away from the distressed and vulnerable human being who is their patient. This is the type of environment that results in both the highest level of professional satisfaction for clinicians and the most effective healing for patients.
Mending the clinician-patient relationship
Is 15 minutes long enough to have a productive clinic visit? Whether or not it is enough time, 15 minutes or less has become the new normal, as primary care clinicians are under increasing pressure to see more patients in a shorter amount of time. This time crunch makes it difficult for clinicians and patients to develop meaningful relationships in which healing can occur, restricts conversations to the patient’s most pressing “complaint,” and contributes to clinician burnout. Primary care clinicians especially need sufficient time with patients to fully understand their health concerns, diagnose correctly, and foster a human connection.
Why are doctors “dropping out” of medicine by the thousands? Why are clinicians feeling disconnected, depressed, and burnt out? It’s more than just the increasing administrative burden on clinicians—it’s the industrialization of health care. Clinicians are caught between their moral values pushing them to do what is best for their patients, and external forces pushing them to maximize profit, for their own practice, their clinic, or their hospital. This struggle leads to what Dr. Simon Talbot and Dr. Wendy Dean call “moral injury”, the anguish and loss that health care workers feel when they confront a system that cares only about profit.
Moral injury is epidemic among health care providers, leading to widespread job dissatisfaction and depression. Moral injury also hurts patients, because clinicians who are burnt out are more likely to make medical errors. Saving our clinicians and patients will require nothing less than transforming our health care system and elevating patient care and clinician well-being over profits.
Electronic Medical Records
Electronic medical records (EMRs) were hailed as the revolution in health care that would reduce medical errors and administrative burden, and make clinical data more accessible. Instead, EMRs were co-opted by private vendors and hospital billing sectors, turning them into vehicles for billing rather than seamlessly providing clinical information. EMRs overwhelm clinicians with administrative work, distract them during patient visits, replicate mistakes that cause medical errors, encourage overmedication, and restrict mobility for nurses. Studies show that clinicians spend more time working in the EMR than they do face-to-face with patients. Some institutions have created a work-around, providing medical scribes who enter data into the EMR for the clinicians. We can do better. Good medicine requires EMRs that provide the user-friendly simplicity of pen and paper with the potential for data collection and instant access to information.
Death by 1,000 Clicks
After Dr. Vikas Saini‘s op-ed, “Death by 1000 clicks” went viral, the Lown Institute led a discussion around systemic issues with electronic medical records systems at the WBUR studios. A later panel discussion featured Dr. Bruce Price at Massachusetts General Hospital.
The Lost Art of Healing: Practicing Compassion in Medicine
In his book published in 1996, Dr. Bernard Lown draws on four decades of practice as a cardiologist and a vast knowledge of literature and medical history to probe the heart and soul of the doctor-patient relationship. As Dr. Lown explains, the art of healing does not mean abandoning the spectacular advances of modern science, but rather incorporating them into a sensitive, humane, enlightened approach to medical care.