COMS has initiated a plan to provide support and services to physicians, physician assistants, and nurse practitioners who are challenged in coping with the demands of current practice. To accomplish this, the COMS Executive Committee has been working with the Oregon Wellness Coalition.
The crisis phone lines, available 24 hours a day, for out counties:
By Tim Hanlon, MD
In My View | The Bulletin | May 7, 2018
As a physician who has practiced in the state of Oregon for 35 years, I am writing to hopefully shed some light on why physicians now spend less time with their patients. When I entered medical practice in Bend in 1980, I had been trained and educated in the profession of medicine. Patients were placed first and their well-being was paramount. Medicine was practiced with high ethical and moral standards. Physicians and patients collaborated to deliver the most appropriate management plan.
This is the professional model that no longer exists. So, what has happened?
To read the rest of Dr. Hanlon's editorial, click title or here.
by Mike Henderson, DO | Guest Column | The Bulletin | April 1, 2018
Physician burnout is a complicated issue, as reflected by the recent Pulse report written by Markian Hawryluk [see next item]. Yet there is much more to the story. Physician burnout reflects the dysfunction of our healthcare system and should be understood in the broader context of the perverse incentives, loss of autonomy, greed, abdication of responsibility and fear of change that defines what is wrong with our current system. The public needs to understand the parallels between physician burnout and the substandard care they receive at exorbitant costs. We can fix only what is known to be wrong.
Click title or here to read Mike's OpEd
By Lindsay S. Hunt, MEd & Andrew Ellner, MD
Harvard Medical School Center for Primary Care
The meeting book posted here identifies the presenters and all the slides they showed at the symposium, as well as a history of the health professional wellness organization in Oregon, the status of the COMS Wellness program, a complete peer-reviewed medical literature bibliography for the 1st 8 months of 2017, and a Bend Bulletin editorial by one of our COMS members. It's a valuable resource for all healthcare professionals, including MDs, DOs, PAs, PsyDs, DMDs, DDSs, NPs, RNs, DVMs, and PhDs in healthcare, regardless of geographic location (at least in the U.S.).
To access the COMS Wellness Program, click here or title.
A comprehensive review of the healthcare professional burnout challenge in Central Oregon by Markian Hawryluk was published in The Bulletin on February 23, 2018.
Click here to review.
A Conspiracy of Silence on Physician Suicide: A Call for a Physician Safety Movement
George D. Lundberg, MD | March 23, 2018 | Medscape At Large
We talk a lot about patient safety, albeit perhaps not enough. But who talks about physician safety? Another young resident physician recently jumped off a 33-story building in New York City to her death. Her body goes to the medical examiner's office, whose job is to officially determine the cause of death (presumably blunt force trauma) and the manner of death (homicide, suicide, accidental, undetermined). Enough American physicians to fill the graduating classes of two medium-sized medical schools are lost annually to suicide. But who performs the psychological autopsy, the institutional autopsy, the sociologic autopsy, the supervisorial autopsy, the autopsy of the failed support network? Who performs the root-cause analysis of this suicide? Who apologizes to the corpse and the survivors and those people, institutions, and other supporters who have invested so much time, effort, and resources into this accomplished physician who is suddenly gone, forevermore unproductive? Where is the early warning system to prevent such catastrophes from being repeated? Where is the study of "near misses"—unsuccessful suicide attempts or serious suicidal ideation by physicians? And where are the interventions when they really matter? I propose a physician safety movement. It can begin as an initiative, just as the patient safety movement started more than 25 years ago.
Where should the physician safety movement be nested? The obvious answer is: in all branches of organized medicine. Perhaps an added function within impaired physician programs could include 24/7 troubled physician hotlines to seek help. Hospital medical staffs, student health offices, residency programs, and employee assistance programs all should have a role [Ed. note: also medical societies, state medical boards].
Click title or here to read entire editorial.
by Robert Wachter, MD, Chair, Dept. of Medicine, UCSF and Jeff Goldsmith, Assoc Prof,, Public Health Sciences, University of Virginia
After a blizzard of hype surrounding the electronic health record (EHR), health professionals are now in full backlash mode against this complex new tool. They are rightly seen as a major cause of professional burnout among physicians and nurses: Clinicians are spending almost half their professional time typing, clicking, and checking boxes on electronic records. They can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians.
Performing several tasks, badly. The EHR is a lot more than merely an electronic version of the patient’s chart. It has also become the control panel for managing the clinical encounter through clinician order entry. Moreover, through billing and regulatory compliance, it has also become a focal point of quality-improvement efforts. While some of these efforts actually have improved quality and patient safety, many others served merely to “buff up the note” to make the clinician look good on “process” measures, and simply maximize billing.
Mashing up all these functions — charting, clinical ordering, billing/compliance and quality improvement — inside the EHR has been a disaster for the clinical user, in large part because the billing/compliance function has dominated. The pressure from angry physician users has produced a medieval solution: Hospital and clinics have hired tens of thousands of scribes literally to follow clinicians around and record their notes and orders into the EHR. Only in health care, it seems, could we find a way to “automate” that ended up adding staff and costs!
Click title or here to read the report
Pam Wible, MD, Eugene, describes her experience in trying to understand why medical professionals commit suicide at such a high rate, and how to prevent them. It takes all of us. To read her report in the Washington Post, click here or the title.
According to a study at the Mayo Clinic (Dyrbye LN, et al. Mayo Clin Proc. October 2017;92(10):1486-93):
•Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.
•Physicians working in states in which medical licensure application questions inquire broadly about current or past diagnosis or treatment of a mental health condition, past impairment from a mental health condition, or presence of a mental health condition that could affect competency were 21% to 22% more reluctant to seek help.
Oregon’s medical license application appears to be the worst in the West in inhibiting help-seeking (cf. map).
Mike Henderson, DO | The Bulletin | October 22, 2017
Have you noticed that your doctor, dentist or other health care provider is spending less time with you? Are they looking at a monitor more than you, not listening, and writing prescriptions instead?
If not, you are fortunate, since the majority of physicians — 54% of 6,880 interviewed in 2014 — experience burnout, and the proportion is steadily worsening.
If you have become increasingly frustrated with health care here in Central Oregon, know that the practice of medicine has become increasingly challenged with more bureaucracy, documentation, insurance hurdles, clerical work, regulations and competition. Know that physicians and dentists commit suicide at twice the rate as comparable, non-physician adults.
One of the primary causes of burnout is the electronic medical records system, which demands that a health care provider spend more time with a computer than with patients. Data input has trumped the provision of the associated health care services it is supposed to reflect. To add insult to injury, the records produced muddy the clinical picture — subsequent readers are challenged to follow the clinical reasoning of the author. Outside the office, clinicians spend another one-to-two hours of personal time each night on non-clinical computer and clerical work.
Another factor is that insurance companies do not negotiate reimbursement rates in good faith. The contracts physicians sign do not specify reimbursement rates. Reimbursement and denial of payment are discovered only after services are rendered. ...
Click here to read the entire editorial
The long held tradition of the physicians’ creed is that we do not need help, that we march forward, unaffected by personal failures or professional setbacks. And we are to devote fully to our patients and their needs. The Physician’s Oath spells out our responsibilities very clearly: patients first and always first.
However, physicians are human.
Donald Girard, MD, Vice Chair of the Oregon Medical Board, summarizes the initiative of the Board to assist medical professionals. To ensure complete confidentiality, he recommends that medical societies adopt and develop their own programs.