Updated: Nov 14, 2019
Understatement: Doctors are tired. Let's count the reasons: Long hours, big worries, many patients, time pressures, new technology, regulation, reimbursement, and on and on. Our guesses are pretty sure to be accurate. But I've always asked each physician I've met, "What burdens you?" The latest answer was a surprise.
Here's what I learned.
Just last week I asked another physician: "What burdens you?" She had recently made a hard decision to leave primary care/chronic care in favor of urgent care. Her response was heartfelt—and not what I expected.
As a former health system CIO, nonprofit executive, health system board member, and active patient advocate on many national committees focused on health information technology, I expected an answer around burdens: regulatory, EMR, quality measures, financial uncertainty, and rate of change. Most providers I have met with mention these, but often as a cumulative effect rather than any single thing.
In fact, many say that although EMR systems are difficult, they could not imagine providing care without the access to information at their fingertips. My conversation with this provider shed new light on "access to information."
"I was uninformed, and my patients were not getting better."
This provider felt hopeless. Hopeless that she could ever make a difference in patients who presented with intractable health problems, mostly problems resulting from or impacted by obesity. She felt that much of the chronic care support, well-baby checks, pregnancy care, disease management, and advising that she provided fell on deaf ears, or was heard but unable to be acted on, or was acted on but unsuccessful. She felt that obesity care was more akin to addiction care than to the current chronic care model. To her, it felt impossible to affect positive change. Not for lack of trying, or lack of training, but for her lack of knowledge. This kind of knowledge: she did not know if the recommended care was taking place, or how the patient was doing, or when to intervene, or when to take more action. She said, "I was uninformed, and my patients were not getting better." Why? Because the care was largely patient self-care and the followup care was often delegated to others in the office for greater efficiency.
Why did this story resonate with me? I am one of those people who succeeded. Twelve years ago, I lost and then kept off 120 pounds. I had resources: I had a trainer, a physician, and a nutritionist who addressed my diet and exercise. I had a family, a dog, a YMCA, a manicurist, hair stylist, a bike, foothills to hike—all helped me build my confidence. I shared my story with this discouraged provider. She took a long pause and replied, "You are the exception." I asked, "If you knew your patients were succeeding in small ways, would that have mattered to you? Would you have felt less burdened? Would knowing have helped you in your career change decision? Would you have felt successful?"
She said, "Yes." She said that knowing her patients were succeeding would have helped her be more confident in the care she provided and feel less burned out. She said it would have made a difference in her decisions.
"I never thought to tell my doctor about my success, or to thank him."
It had never occurred to me that a provider's knowledge of patients' progress (or even lack of it) and life successes (or not) following the provider's recommendations, care plans, or advice was important to the provider's well-being. I think back on my journey: it took over a year to complete. Although my provider had given me the “diet talk” and helped me see the possibilities and consequences of weight, my nutritionist (2 visits), my trainer (3 times a week), and the YMCA (3 times a week) had the most impact on my long-term success. My insurance changed, and my provider was no longer in my network. I never thought to tell my doctor about my success, or to thank him.
Certainly this provider changed her career path for multiple reasons. But each of us wants to know when we make a difference. Not knowing leaves a void. As a HIT advocate for patients, I now embrace a whole new spin on patient-generated data, which until 2 weeks ago I had thought of only in terms of the patient's well-being, my well-being. I remember: Dr. Farzad Mostashari, when asked if patient-generated data was important, he replied, "Isn’t it better to know?" He is right.