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A System Without Slack: How Delivering Care Harms the Health of Physicians

  1. Elaine Schattner, MD, MA Lifelong patient, Advocate, Journalist Clinical Associate Professor of Medicine Weill Cornell Medicine, New York, NY A System Without Slack: How Delivering Care Harms the Health of Physicians
  2. Having healthy and experienced doctors is good for patients. Elaine Schattner, MD, MA
  3. The Personal Toll of Practicing Medicine Schattner, E. Health Affairs. 2017 Feb 1;36(2):371-375.
  4. “Older” Physicians Work Long Hours History: 1988 – New York State began regulating schedules of intern and resident doctors; 2003 – ACGME implemented work-hour limits for all physicians-in training (interns, residents, fellows); Yet no rules restrict hours of “senior” physicians. Many specialists routinely work: • 36 hour shifts; typical weekends (~64 hours) on-call; • weeks at a stretch, on-service supervising younger doctors Why this matters to the public: Unregulated doctors’ hours may endanger patient care. Grueling workloads harm physicians’ long-term health and diminish the medical workforce. Elaine Schattner, MD, MA
  5. Elaine Schattner, MD, MA
  6. Doctors Do Get Sick. Like other people: Cancer, heart and vascular disease, arthritis, diabetes, Parkinson’s… Depression and mental illness Substance abuse (Pregnancy) High risk: Infectious diseases: hepatitis, flu & other viruses, Tb… Suicide Stress-related conditions?Portrait of Dr. Alfred Newman, 1896 National Library of New Zealand Elaine Schattner, MD, MA
  7. Physicians’ Health is a Delicate Subject • Privacy issues: • treatment at place of work • colleagues as providers • Stigma of mental illness • Need to inform patients? • Responsibility to tell coworkers, supervisors and employers? • Insurance and malpractice concerns House (Fox, 2004 - 2012), fan club image Elaine Schattner, MD, MA
  8. Depression ≠ Burnout Depression is a clinical diagnosis with symptoms (mood impairment) manifest at home and at work. Burnout usually refers to a constellation of symptoms relating to behavior at the workplace. Signs of burnout include: • emotional fatigue • depersonalization • lost enthusiasm for goal(s) → Providers stop caring. Burnt out? Depressed? Simply tired? (Tait D. Shanafelt, et al. Arch Intern Med. 2012;172(18):1377–1385.) Elaine Schattner, MD, MA
  9. A System without Slack: How to Fix it? Suggestions: 1. Set a slower pace for practicing: Be realistic about expectations in clinical care; Allow time for communicating, reading and reflecting. 2. Provide more support staff to all doctors: Nurse practitioners and physician assistants; Secretaries, phlebotomists, clerks, etc. 3. Take advantage of telemedicine and other technology; 4. Train more doctors, including specialists. $$$ compassion Elaine Schattner, MD, MA
  10. Thank you!