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Curbside Consult with Dr. Jayne 9/9/19

September 9, 2019 Dr. Jayne 4 Comments

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Lots of companies are talking about gamification as it relates to patient engagement and management of chronic conditions, but I never thought I would see an app designed to gamify strategies to reduce physician burnout.

The folks at the American Medical Association have released an app that tries to make a game of dealing with this serious issue. Titled “HealthBytes,” the app is designed to teach strategies to help physicians optimize their practice’s operations in an attempt to reduce physician burnout. The app can be played on a PC or smartphone. The AMA states “no matter how many times you play the game, you are bound to learn something new each time.” I’m not sure what kind of research they did to drive the creation of this game, but in my experience the last thing that burned out physicians want to do is experience anything office related if they don’t have to.

The AMA admits there is a time pressure element to the “Practice Master” game within the app. Players have four minutes to play through a physician scenario, including meeting the team, designing “my dream team,” optimizing documentation, conducting a patient visit, and creating a well-being plan for the physician and the team. Following that exercise, providers can share their score, play again, or consult AMA content designed to “offer innovative strategies to allow physicians and their staff to thrive in the new health care environment.”

After finishing my recent read of “Code Blue” by Mike Magee, which names the AMA as one of the principals behind the dysfunction of the US health care system, I find it only mildly amusing (but significantly distasteful) that they’re positioning themselves as experts ready to help solve the problem. One of my colleagues refers to the AMA (along with payer executives and federal regulators) as part of the Medical Axis of Evil.

The AMA is trying to be all over the issue of burnout, including offering the trademarked “American Conference on Physician Health” that will be held September 19-21 in Charlotte, NC. The organization is co-hosting with Stanford Medicine’s WellMD Center and the Mayo Clinic Department of Medicine Program on Physician Well-Being. The conference website lists of statement of need that “Physicians’ professional wellness is increasingly recognized as being critically important to the delivery of high quality health care.” It also notes that the meeting “is designed to inspire organizations throughout the country to seek ways to bring back the joy in medicine and achieve professional fulfillment for all our physicians.”

The sheer fact that presentations will include more than 70 wellness projects and programs illustrates the significance of the issue of burnout. I was surprised to see that the two-day conference costs $825 for AMA members ($925 for non-members), with a whopping $25 discount given to presenters who only have to pony up $800 to attend.

AMA is also offering a practice transformation boot camp immediately prior to the conference, at the bargain price of $279 for the day (although you do get a $100 discount if you register for both). Tack on an additional $214 per night for hotel accommodations plus meals and travel. Frankly, if I was going to spend that kind of money, I’d be heading to the beach since that is my proven strategy for improving my own physician well-being. I noted on the website that AMA recently extended the registration and now it closes a mere nine days before the conference, perhaps an indicator of what potential attendees think of the conference.

I frequently read articles about burnout, physician wellness, resilience, etc. and they often portray clinicians in the trenches (not just physicians – it’s all of us) as somehow being lacking, therefore we are subject to burnout. If we could just be more resilient, if we could just explore mindfulness, if we could just tweak every fiber of our practice’s operations, we would be OK. If we could just embrace the therapy dogs, take a walk in a grassy meadow at lunch time, or build the ideal care team, we’d be able to dodge the flaming arrows we encounter on a daily basis.

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In the spirit of fairness, I gave the game a try. I found it simplistic and revealing only of the information that most of us already know. I made the leaderboard on the first try even despite being penalized for answers that were situationally correct but not what the game was looking for. It suggested hiring a scribe, which it refers to as a CDA (clinical documentation assistant – always great to add more acronyms), along with getting the IT team to restructure my EHR inbox. Good luck with that latter suggestion in a large health system environment where any changes to the EHR require the approval of three committees, a resource analysis, and endorsement by the person behind the curtain.

I admit I played it at work with the sound turned off, so maybe I missed out on some kicky soundtrack that might have made it more enjoyable, but mostly it just made me more aggravated than I already was about the situation.

An increasing body of research and commentary is describing “burnout” as the wrong word for the situation. Instead, they’re labeling this phenomenon as moral injury, the damage that occurs to an individual’s moral conscience as a result to the trauma we face in practicing medicine. The original definition of moral injury as coined by professor Jonathan Shay included three components: 1) when there has been a betrayal of what is morally right; 2) by someone who holds legitimate authority; and 3) in a high-stakes situation.

Although other definitions have evolved, I think this still holds for a large number of situations that healthcare providers face daily. One more recent definition from Brett Litz and colleagues describes that “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long term, emotionally, psychologically, behaviorally, spiritually, and socially.”

Tweaking the process for the office’s morning huddle isn’t going to do much to address the more deep-seated issues at play here. It is insulting for the AMA to put this in front of its physician constituents.

People often ask me how I cope with the craziness of healthcare, especially when you add the craziness of information technology on top of it. On some days, the answer is “barely.” Fortunately, I have a support system with friends and colleagues who understand what it’s like to work in this environment. I try not to take it too seriously and have modified my clinical career to one that is healthy for me. Being in traditional primary care was not, but providing episodic care is better. Doing clinical informatics work helps me feel like I’m doing something to help my fellow clinicians, regardless of the muck in which we operate on a daily basis. I also spend quality time on my treadmill watching utterly mindless shows on Netflix and there’s a smattering of time leftover for music, as well as my arts and crafts hobby. It’s a lot of work to stay sane in this environment.

What do you think of the response of the AMA and other professional organizations to the problem of burnout in healthcare? What would be a better answer? Leave a comment or email me.

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Currently there are "4 comments" on this Article:

  1. Thanks very much. This is very well written.

    Things that I strongly believe:

    – The use of the term “provider” when people mean “clinicians” or “physicians” only adds to “moral outrage” – we should reject participation in anything where the word is used;

    – If the AMA was fighting for us, they would be loudly demanding truly radical restructuring of US health care rather than tweaking the existing one with apps, conferences, wimpy comments on CMS rule-making, etc.;

    – The solution to our problem isn’t going to come from the AMA until they recognize that they helped to create the problem.

    Keep up the good work.
    Dr Joe

  2. I’m intrigued by the concept of “moral injury” as it applies to folks in the medical fields. I recently read an deeper look at the concept here: https://illusionsofautonomy.wordpress.com/2019/06/02/moral-injury-in-doctors-an-exploration/

    (I have no connection to that blog or its author other than as a reader)

    In particular the author asks “Is it a bad day, in medicine, when people get ill and die despite our best efforts? Or is that just ‘a day’.” He comes to the conclusion (in part) that the feeling of “I could have done more if I had more resources” is distressing, but not truly moral injury (at least according to the definition he’s working under). Moral injury can (and does) happen to physicians, but “moral injury” shouldn’t be thought of as a replacement for the much broader phenomenon of “burnout”.

    I don’t have an answer and am not a clinician, so I also don’t have first hand experience. But I agree with the sentiment that a gamified app is unlikely to move the needle.

  3. Burnout is a real condition, but for most of organized and academic medicine it has provided a handy new topic to generate more content for sale and consultation fees. As the old saying goes, “Those who can, do and those who can’t become teachers. Those who cannot teach become consultants”–with all due respect to you, DrJayne!

  4. Jayne-
    Thanks for this thoughtful article – and for the “shout-out” for CODE BLUE. Would value greatly your full review. On topic here, new residents are thrown into “war zone” conditions with no psychological preparation or ongoing mental support. The experience is made worse by excessive work hours, sleep deprivation, and the demands of doctoring – compassion, understanding and partnership with patients. In short, we ask a lot of these human beings and hope for the best. Under a rational system, we would better protect and support this most valued human resource. But as CODE BLUE exposes, our system pursues cure over care, and profit above all else. The key to physician burnout is universality, solidarity, and strategic health planning – including the health of doctors and nurses.
    Best, Mike







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