Podcast Recap: Preventing physician burnout
Between 35% and 54% of doctors and nurses experience burnout, according to a report issued by the National Academy of Sciences Engineering and Medicine (NASEM). The report found an estimated 60% of interns and residents experience burnout as well. The ACDIS Podcast: Talking CDI examined this topic in an episode titled “CDI’s Role in Preventing Physician Burnout.”
According to Analyn Dolopo-Simon, ACM, CCDS, CDI program director for University of California-San Diego (UCSD) Health, the issue is very apparent to her CDI team as they’re present on the floor with the physicians and interacting with them daily. In fact, many of the CDI staff have known the physicians since they were interns, so they have an ongoing, collegial relationship.
“We’ve heard how long these hours are that they are working to respond to queries and to document, among other things,” she said on the podcast. In addition to CDI queries, the physicians are also working on patient care documentation and fielding queries from coding and other departments, Dolopo-Simon said.
“I’ve always known that the [documentation] they’re doing is … usually late [at night] after their shift, so we keep this in mind when interacting with them,” she said.
CDI specialists are, of course, aware of the number of queries they send themselves, but they may not know how many other demands the physicians have on their limited time. CDI, according to Dolopo-Simon, can be an instrument of change, however.
UCSD Health has set up a CDI excellence program under the chief of coordination and chief medical officer. “It is basically a group of professionals who have the tools and requirements to educate and teach,” Dolopo-Simon said, including the following departments:
- Population health
- Case management
The goal of the program is to simplify the messaging and communication between physicians and departments while onboarding attendings, interns, and residents. “All of us have the same message about documentation,” she said: “Make sure it is as accurate as possible.”
UCSD Health is trying to streamline the onboarding and messaging process and make it even more effective, said Dolopo-Simon. One method is to simplify queries by creating templates. “This way no matter where you get the query from, it is the same template, so everyone knows what to expect,” she said.
The UCSD program was a grant recipient of the Sanford Institute for Empathy and Compassion, which has also helped them in their effort to reduce physician burnout. “Sanford was concerned about burnout and caregivers leaving the profession because of the crushing workload and documentation requirements,” noted Dolopo-Simon.
Beyond CDI efforts, the grant will allow the organization to look at the neurobiology of compassion in an attempt to identify root causes of burnout and help find methods to prevent it. “We have a huge research in neuroscience,” she said. “We have the key researchers in place to look into this and hopefully positively impact future residents and interns.”
There needs to be a balance between friendliness and the reality of productivity requirements.
“Our CDI program is on the floor doing concurrent documentation,” said Dolopo-Simon. “We are trying to impact the documentation so retrospective queries can be lessened and we can discuss cases while the patient is currently being treated.”
While some physicians may view CDI as a bother, some appreciate integrating with CDI efforts and goals. Because of these differing perceptions, CDI programs have to balance their queries against extending compassion to those who may be feeling under the gun. One of the best approaches to this problem, Dolopo-Simon said, is an awareness of physician scheduling.
“When we first come in, we do a download and say what assignments are on our schedule and follow up on queries,” she said. However, she added, the CDI team knows that in the morning between 7 a.m. and 10 a.m., the physicians are actively rounding and discussing patients—so that may not be the best time to expect a query to be answered. “We have to be cognizant of that.”
“We try to go through our schedules and reviews while on the floor,” she said, “because sometimes people will see us and come up and say that they have a few minutes if we need anything. So those 10 seconds of human interaction really help a lot versus another electronic ping.”
Ultimately, Dolopo-Simon stressed that human interaction and compassion toward physicians goes a long way to reduce burnout. “We end our queries thanking physicians for their response,” she said; “that makes it more customer-friendly.” She added that being present and available for feedback allows people to vent, and sometimes just being heard has a huge effect on someone’s mood.
“Also, chocolate,” she added. “You have to understand that people are humans.”