by Jeff Moody, MD
Featured in the July-August 2019 Colorado Medicine Colorado Medicine.
I was surprised at how easily it broke in two. I had finally reached the end of my rope with my EMR. Now what I had to show was the cracked halves of my keyboard in my hands, neatly divided in the middle, with stray, homeless keys strewn across my desk. The death-of-a-thousand-cuts interaction that I have with my EMR usually involves endless clicking, freezes and crashes. I had been pushed past my breaking point. Before I knew it, my keyboard was in pieces on my desk. I thought, “Is this what my work life has become?” I personally know of at least two other physicians who have smashed computers or screens while expressing their “frustrations” with an EMR. The endless loop; the failed integration; the helpless, hopeless time sink that had become the documentation of my patient visits had finally gotten the better of me. And, to date, no randomized study has proven the utility of electronic medical records in improving health care or reducing costs. I have to say that I was definitely feeling burned out. I still loved practicing medicine, but my work/life balance was out of balance. My keyboard was beyond repair. Hopefully, my life and my career were not.
Since the “keyboard event,” as we call it in my practice, I undertook a comprehensive approach to personal and systemic changes on a number of fronts to reduce and eliminate burnout. Research shows that both personal and systemic changes must occur to produce long-lasting, significant change.
It is helpful to think of your current situation as a box of your construction (no blaming, just naming), with a floor, walls and a ceiling. The floor is your cumulative learning, experience and education. The walls consist of work environment, mental, physical, financial, spiritual and social elements. The ceiling is any limiting beliefs you may hold.
To effect change, assessment and action are critical. It is a simple process that when repeated is like peeling an onion. Start with the outer layers, then progress to the next, once you have success with the first.
To assess burnout, pick first the one aspect of any “wall” of your box, or current situation, that seems to be the major driver of your burnout. In other words: What makes your blood boil on a regular basis? Write that down. Next, think of one action or planned intention you can take to improve, change or reduce the problem. Write that down. Let money or cost for the solution be no object in this thought experiment, for now. It will expand your creativity for possible solutions.
Next, put a deadline on your action plan. Behavioral science research shows that planned intentions with actions and deadlines triple the likelihood of completion of the task. Finally, take action on your plan!
You have successfully attacked your first burnout driver. Now, repeat with whatever is next on your list of problems.
Systemic changes are addressed in the same way, but simply require interaction with your group, employer or hospital system. Engage with your system, let them know how you are doing, what is good and not so good, and what you need to care for yourself. That should start a very productive conversation. Then, repeat the problem solution process detailed above. Problem. Intention. Deadline. Action. 1. 2. 3. 4. No more burnout anymore. Sorry, couldn’t resist.
Let me give you examples of how this process worked for me personally and systemically. Personally, I had some real issues with insomnia, waking up at 2 and 3 a.m. thinking and stressing about my practice and any other problems going on, and then being completely unable to return to sleep, making the next day a draining, fatigued fog. This was something affecting the physical wall of my box. So I wrote down “insomnia.”
Next, I educated myself about strategies for treating insomnia. I gave myself a week deadline to learn and start implementing new strategies. I wrote down four of the strategies I thought I could apply. I stopped using devices 30-60 minutes before bed. I “scheduled” time to attack my insomnia-creating practice problems during the day. I had a bedside journal for writing down any of these thoughts when they occurred at night to get them out of my head. Finally, I used meditative breathing while drifting off to sleep, counting the breaths. I rarely make it past six or seven before I am asleep. If I wake up in the middle of the night, I repeat the breathing process with very good results.
Systemically, our EMR was very inefficient (I know, surprise!) at generating new or return notes, taking me about 30 minutes per day just to get them to open. So I wrote down “EMR note opening.” My strategy was teaching my medical assistant how to open the notes prior to me seeing the patients. I gave myself a one-day deadline. Teaching her how to open new notes took 15 minutes and permanently saved me more than 30 minutes per day. Voila! I magically had 10 hours per month and 120 hours per year of my life back!
You may think this plan seems too simplistic or straightforward. But the real issue is lack of action once a problem is identified.
Doctor, diagnose and treat this problem! We all do this all day, every day for our patients. Turn your energy, initiative and integrity towards yourself.
This is what I have done for the past two years, and continue to do every day. The wonderful aspect of taking action is that you are taking back your control. The peace, sense of calm and new hope for my future practice of medicine, while taking action, have empowered me. I am no longer a helpless bystander, but an active change agent in my practice and my life. Small changes over time yield large results. Even a 1 percent per day improvement, if compounded over a year, will yield a 3,700 percent improvement. I’ll take that.
And, my new keyboard and I are doing just fine!