A doctor burning out and two who aren’t


Here’s the truth I wanted to share,

Improving medical care.

     Here they do what they should

     And it’s coming out good

I’m just trying hard not to stare.

In the Chicago airport I listened to a man carrying on a serious conversation.  “It’s a problem,” he said.  “And it’s been a problem for a long time and it needs to get fixed.  And when I get back, no, YOU listen, and when I get back, I’m going to, no, you’re NOT, now YOU listen.  He needs to have an admission arranged to (I didn’t catch the name C hildren’s Psychiatric Hospital.  Yes.  Locked unit.  Now you call Dr. (I missed the name), and you tell him…I told you already.  Yes, it’s a problem.  Do you have it?  Now it’s serious and I’m going to be gone for two or three days but it needs to be done, I won’t be back to Richmond till Sunday and you need to handle this.  It’ serious.  And when I get back I’m going to work on fixing this problem, it’s gone on way too long.”

Clearly, spoken by a doctor in need of a vacation who makes sure his stress follows.  I suspect he has trouble giving up control.

He stood my height, and outweighed me by eighty pounds.  What little remained of his hair was white.  Bags under the eyes, skin hanging on his face, and entrenched frown lines bespoke chronic sleep deprivation and rapidly approaching burnout.  When he stood his shoulders sagged under the weight of his worries and he walked with the painful-foot roll.

He stood in line.  I wondered how much he generates his own misery and how much comes to him unsolicited.

Today I worked in Grand Island, Nebraska.  The clinic anticipates going from paper based to electronic medical records in March.  They will start that painful process much better prepared than any other medical office I’ve seen.   The doctors have maintained the paper charts well; the staff purges information not likely to be used on a regular basis and stores it for ready access.  Training the staff on EMR ranks as the transition’s hardest part.  Right after that comes the uploading of information from the paper chart.  The data will move much more easily than I’ve seen it move in the past.

Three of the patients I saw today suffered from problems related to the three-week rule:  twenty-one days after a stressor, the patient gets sick or gets injured.  None of the people I saw today smoke; two have retired.  Work moved at a reasonable pace, and the patients came with realistic expectations. 

The records show consistently excellent, thorough medical care.  Some of the more esoteric lab tests I could think of were already on the chart.

I haven’t met the docs here, but I suspect that the physician who went on vacation left behind his cares and didn’t take any loose ends to fetter his rest.  The doctor who puts first things first runs little risk of burnout.

I’m learning a great deal from this experience.  I look forward to figuring out the elements of the corporate subculture that bring this high level of functionality in the context of thorough medical care.

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