Exhaustion Leads to Burn Out
With our ever changing healthcare environment – full of shifting policies, cost reduction efforts and insurance mandates, it can be easy to forget about the most critical aspect of healthcare delivery: the physicians. However, with decreased reimbursement rates and general industry uncertainty, more and more individuals are opting out of the medical field.
For those remaining, the current healthcare system brings increased costs, misaligned incentives and administrative tasks – burdening our physicians. And while we may not be able to solve these issues simply, studies have shown that decrease in sleep and longer working conditions certainly do not help our physicians.
So, if we have fewer new physicians entering the market and our current physicians are burdened by healthcare pressures, it's no wonder why burnout has become a huge topic of debate in recent months.
How lack of sleep is impacting medicine
Many studies over the past several years have investigated the link between sleep deprivation and patient outcomes. In most cases, outcomes from a rested surgeon do not differ greatly from that of an unrested surgeon.
"Studies failed to demonstrate any significant clinical differences between the sleep deprived and non-sleep deprived groups (www.surgeons.org, Fatigue Review, 2009-06-17)."
However, this doesn’t tell the entire story. A study published by the National Center for Biotechnology Information (NCBI) found that "the assessment of the impact of sleep deprivation on surgeons' performance during night shift is complex. Surgeons circadian rhythm is affected." And while it seems that patient outcomes may not be affected by lack of sleep, the study goes on: "it appears that the surgeons are able to compensate for the effects of sleep loss (www.ncbi.nlm.nih.gov,The Impact of Sleep Deprivation on Surgeons' Performance During Night Shifts, 2014-09)." Perhaps, as this study suggests, lack of sleep really does impact physician performance but because the environment, operating room procedures and support staff are critical to any surgeons' success, lack of sleep is compensated for.
Reimbursement rates affected
That’s not all – today, physicians and hospitals are reimbursed based on a variety of factors - patient satisfaction rates being one of them. And tired, burnt out physicians, tend to attract lower patient satisfaction scores. President of Heka Healthcare, Dr. Kristy Taylor sites an AMA and Mayo Clinic study which found that 54.4% of providers admitted to suffering from at least one sign of burnout. A second survey from the Physicians Foundation revealed that 63% of its respondents had negative feelings about practicing medicine, 49% experienced feelings of burnout and 49% would not recommend a career in medicine. Dr. Taylor suggests that "when health care providers are emotionally <and physically> exhausted, patient satisfaction rates and quality of care is reduced (www.huffingtonpost.com, Increased Doctor Burnout Rates Lead to Decrease Patient, 2017-07-26)."
What should we do with this information?
While lack of sleep may not impact a patient's medical outcomes –improving a physician's relationship with his/her work turns out to be pretty important. So, within our current, complicated healthcare system, what techniques can providers, practices and even patients employ to help?
1) Providers – It is well known that healthcare providers lead relatively unhealthy lifestyles. Break that cycle and focus on eating well, exercising and closing early one day a week to get home to family and friends.
2) Practices / Staff– Systems and procedures can be incredibly important when designing an effective workday. Be sure your scheduling software properly protects lunch time. Consider investing in electronic health records that encourage the use of checklists during patient handoff. Establish provider wellness as a quality indicator that is regularly measured in the practice.
3) Patients – Patients must be encouraged to prepare for their physician encounters. Physicians have competing priorities and many pressures in their day. If patients prepare for their appointment with their questions outlined, even the busiest doctor will provide more meaningful information. And more meaningful information leads to a more meaningful visit.