Bestseller brings burnout tips to AAD

Abraham Verghese, MD, combined history and modern day in his assessment of today’s health care environment. Dr. Verghese was the guest speaker at Sunday’s Plenary session (P151), presenting “The Pathology Within: Burnout, Wellness, and the Search for Meaning in a Professional Life.”

“You’re the last bastion of people who actually examines patients,” Dr. Verghese told attendees. “We’re living in interesting times. The revolution ahead of us will make the Industrial Revolution look like nothing at all.”

Dr. Verghese discussed the importance of the doctor-patient relationship by going back in time to review the history of the diagnosis and early diagnostic tools. He placed significant importance on The Doctor, an 1891 painting by Luke Fildes that depicted a Victorian-era doctor sitting next to a perilously ill child while the parents kept vigil. There are no early diagnostic tools of the time in the painting. According to Dr. Verghese, it symbolizes the intimate concern doctors have for their patients.

Flash forward to 2018 when the computer screen, big data, and artificial intelligence often feel like the No. 1 diagnostic tool, he said.

“The ‘iPatient’ (the computer) has eclipsed the patient,” Dr. Verghese said. “And there are consequences to that shift.”

Those consequences include patient dissatisfaction, physician wellness, medical error, and loss of ritual. Patient dissatisfaction is obvious in the comments made by many patients today. Physician burnout affects 50% of primary care physicians, Dr. Verghese said. It’s systemic and may be tied closely to increasing regulations, or what the health care field calls the “4,000 clicks a day problem.”

“With today’s regulations, it takes seven clicks just to order a baby aspirin. And the clicks go up from there,” Dr. Verghese said. “One hour of direct clinic, face-to-face time with patients equals two hours on the EHR. And scribes aren’t the answer. The last time we had scribes was in the Roman Empire. We need better ideas.”

Medical error goes without saying, he said. When a physician’s attention is on the screen more than the patient, there’s a tendency to make errors.

The most significant change of today’s doctor-patient relationship, however, may be loss of ritual, according to Dr. Verghese. Rituals are important and are about transformation. Dr. Verghese shared a story about his decision to spend more time listening to his patients. He was surprised that the patient he was examining didn’t want to stop talking about his health. As Dr. Verghese moved forward with a physical exam, the patient began to quiet.

“As the patient accepted what I had to offer, we began a partnership toward wellness. Rituals signal the crossing of a threshold. This was the beginning of a partnership where one partner — who didn’t know me — was telling me things they wouldn’t tell their spouse or their rabbi,” he said.

Dr. Verghese reminded attendees that patients judge their physicians by how they perform at their bedside.

“We are given the privilege. We must do it well. Patients can tell when you do a half-ass job. Just as you can tell when you’re in the hands of a sloppy hairdresser,” Dr. Verghese said.

As far as the future of artificial intelligence on medicine, he said, it only provides a prediction. What you do with that information is what matters.

“One thing that will never change is that the person who is ill is looking to connect with you — another human being with the training and expertise that matters,” he said. “The secret of care of the patient is caring for the patient.”


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