Clifford Goldsmith | B.Sc., MBBCh (MD), US Chief Medical Officer, Microsoft
I am proud to count myself among the cadre of physicians who incorporate healthcare informatics in their medical practice. We may have downsized our clinical practices, but we remain as strongly committed to the principles of the Hippocratic Oath as we were when we took the oath in medical school. Our priority has been and always will be to put the health and safety of our patients front and center of everything we do in our profession.
I remember how fervently we worked in the first decade of the 21st century to introduce computerized physician order entry (CPOE) into our systems. We understood from the Crossing the Quality Chasm report (IOM, 2001), which identified and recommended improvements for US healthcare, that CPOE would make our patients safer. I also recall the disappointment we physician informaticists felt in the following decade when it became clear that information technology (IT) was one of the contributing factors to physician burnout. IT bore the brunt of the blame, sometimes unfairly, for alienating physicians from their craft of medicine.
The turning point was marked by Bodenheimer and Sinsky, 2014, who explicitly added a fourth tenet, “improving the work life of healthcare providers,” to the other three tenets of “enhancing patient experience, improving outcomes, and reducing costs” to create the quadruple aim: a pivotal underpinning of a highly effective healthcare system.
Unfortunately, we continue to see an increasing number of reports that indicate rising percentages of physician burnout to this day. In my opinion this is not a physician problem, but a systematic alienation that keeps physicians from doing what brings them a sense of satisfaction, well-being, and following their “calling.”
Hartzband, MD, and Groopman, MD, eloquently capture how the COVID-19 pandemic offers insights into how we bring back a sense of joy to the work of physicians (Physician Burnout, Interrupted, NEJM, June 2020). As the pandemic surged and uncertainty grew, physicians, nurses, and all healthcare workers became essential to the prevention, treatment, and survival of everyone across the globe. Clinicians worked urgently for excessively long hours under dire conditions, with a lack of protective equipment and a severe shortage of beds and ventilators.
Systems and processes changed abruptly to allow physicians to deliver expedited care in a more effective manner with waivers like payment for virtual visits and streamlined documentation. We saw thousands of public displays of gratitude and appreciation for physicians, nurses, and all health workers across the globe. For the moment, clinicians are feeling that inner satisfaction of helping and healing others that drew them to the profession in the first place.
A new U.S. Health and Human Services (HHS) survey of 320 US hospitals from February 22-26, 2021, highlights the massive toll a year of treating a global pandemic has taken on the health system, including the trauma and stress experienced by medical staff operating in “survival mode” for such a lengthy period and facing unprecedented numbers of deaths every day.
I am concerned that as the pandemic is brought under control, and the health system overloads with patients who have put care on hold due to social distancing, we will see another surge in physician burnout. Silverman, MD, described the pre-pandemic frustration of physicians in the New York Times: “relentless reminders of tasks we haven’t completed, supplications to correct our documentation for billers, and daily, jaundiced reminders: You are currently deficient.”
We must not allow this to happen. We need to take a hard look at ourselves and make these regulatory waivers permanent. We need to implement health information technology that ensures good management practices, while still empowering physicians with a sense of autonomy, competence, and connectedness.
Here are a few examples:
Virtual visits became a necessity during the pandemic, and many hurdles were removed to make them easier for patients and physicians alike. If physicians are to provide high–quality care, virtual visits will need to be enhanced with technology that captures the clinical signs that physicians have observed for centuries. Remote Internet of Things (IoT) technology is ready to provide information about heart and respiratory rates, blood pressure, movement analysis, auscultation, and much more. Using remote monitoring solutions can help physicians feel more competent and confident and, consequently, less burned out.
The pandemic has spotlighted the longstanding existence of health inequity, and physicians can no longer ignore this blatant disparity. We need to root out systemic inequality so that we continue to feel the intrinsic motivation of our Hippocratic Oath, of treating everyone equally, regardless of their circumstances. I believe aligning our practice with these ethics is vital to reducing physician burnout.
We need clinical and operational analytics that can simultaneously measure patient outcomes and clinician experience. Microsoft has introduced Viva, a new worker experience platform, that provides key insights for top-of-mind issues including well–being, burnout, agility, and customer focus. Incorporating these personal experience tools will contribute to reducing burnout in our health information technology environments.
On this National Doctors’ Day 2021, let us pause for a moment to show our gratitude to physicians on the frontlines of healthcare, for all that they do every day to keep us safe and healthy. Let us dedicate ourselves to expanding the use of health information technology and using it as a foundation for better healthcare and as a medium for delivering a joyful and satisfying experience for clinicians, and patients.