The link between overuse and burnout

Clinician burnout—feeling unfulfilled, emotionally exhausted, and detached—has become an epidemic. While frustrating electronic medical records play a significant role in burnout, there is more to the issue than just administrative burden. Clinicians are facing a crisis of morality.

Dr. Simon Talbot and Dr. Wendy Dean’s use the term “moral injury” to describe what happens when health care workers who are following a calling to help others confront a system that cares only about profit. Clinicians usually choose medicine as a career because they care about helping people, but they enter a health system that prioritizes volume over value, and forces them to churn through patients with no time to make a real connection. This disconnect between what clinicians want to do and what they spend their time doing creates stress, depression, and, eventually, burnout.

The movement to bring attention to moral injury highlights the ways in which overuse and burnout are linked. The systemic factors that lead to overuse and waste are also hurting clinicians.

In a recent piece in Kaiser Health News, journalist Melissa Bailey interviews doctors who are experiencing moral injury and speaking out about it. Dr. Keith Corl, assistant professor of medicine at Brown University, said that the “fast and loose” model of care in many emergency rooms pushes clinicians in the emergency department to conduct excessive testing instead of conducting a thorough physical and history.

This type of practice, known as “provider-in-triage,” allows EDs to churn through many more patients, but often results in unnecessary testing and additional costs for patients (and more revenue for hospitals). Although one might think that conducting a battery of diagnostic tests right away would solve the patient’s problem more quickly, skipping the physical and rushing to test can miss obvious clues. Korl tells the story of one man who went to the emergency room for chest pain and received a chest x-ray, an electrocardiogram, and blood work. However, when Korl conducted a physical exam, it was apparent from a distinctive rash that the patient had shingles.

“I didn’t need a chest x-ray, electrocardiogram, or blood work to make that diagnosis. Nevertheless, he left the hospital that day with a bill for thousands of dollars,” wrote Korl.

We need to move toward a system of right care in emergency medicine (and in all other specialties), in which clinicians and hospitals are paid for value rather than volume, and clinicians are allowed to spend the time they need interacting and connecting with patients.

Without these system changes, we will not only increase waste in the health system— we will “grind good docs and providers out of existence,” said Korl.