A System Without Slack: How Delivering Care Harms the Health of Physicians
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
The Personal Toll of Practicing Medicine
Schattner, E. Health Affairs. 2017 Feb 1;36(2):371-375.
“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
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
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
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
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