Until we fix electronic medical records, we’ll keep losing good physicians

Could we lose hundreds, perhaps thousands, of physicians to bad software?

I’ve written about doctors’ frustrations with software before, but recent studies have now linked electronic health records (EHR) to physician burnout. That means the software that runs billing and medical records and occupies doctors’ hands and eyes for much of the work day is a direct contributor to feelings of apathy toward patients and medicine, depressed or angry mood, cynicism and lack of feelings of accomplishment.

We do not hear about such staggering dysfunction in other professional fields. One reason is that we lack the appropriate division of labor in medicine. Lawyers have legal secretaries and court reporters — can you imagine a lawyer stopping in the middle of a divorce deposition to catch up and type everything that was just said? Television writers have assistants to take notes during their meetings and keep all the plot points organized. Senators have fleets of aides to attend to their every need, so that they never have to take notes. Some journalists hire transcription services to type up their interview notes, so they can focus on writing.

The idea of professionals working as their own secretaries seems absurd. Yet for decades, doctors did fine taking their own notes by hand. The real trouble came when health systems switched to illogical medical billing software thinly disguised as charting software. Suddenly, doctors became transcribers and medical billers — with less actual time to do all those tasks. For the most part, the software does not flow in the way doctors are taught to think and document patient visits in medical school. Because you cannot just jot down a patient’s just-remembered allergy to eggs, you have to hunt and peck for where to record it on the computer. All of this contributes to decision fatigue and distraction from the real task at hand — diagnosing and treating patients. No wonder doctors suffer burnout. In order to adequately document a complex visit in a typical EHR system, the physician might need to do about an hour of clicking. No one ever actually has that hour, so medical notes end up harried and formulaic. This is dangerous for patients as well.

The real trouble came when health systems switched to illogical medical billing software thinly disguised as charting software. Suddenly, doctors became transcribers and medical billers — with less actual time to do all those tasks.

Now doctors are wondering every day, often quite publicly, whether it is all worth it. Think about that: Physicians are so dissatisfied they are publicly lamenting on blogs about their dilemma about whether to continue working. It is right there for their employers to see. One gets the sense that if these doctors did get fired as a result, they would not be terribly upset. This collective anomie heralds an unraveling of the health care system if doctors start quitting in droves.

The rampant physician burnout spreading across U.S. medical centers, according to Southern Illinois University’s Dr. Susan Hingle, calls for real changes, and not just “additional training on the software.” Face-to-face time with patients makes doctors happy and productive. Rumor has it that patients like it, too.

The glacial pace of innovation, adoption, and refinement on the part of both as software vendors and their customers — most health systems are not even running the latest version of software available, and constant suggestions on usability from doctors often fall on deaf ears — means the suggestion that “the software needs to get better” doesn’t do enough to alleviate physician burnout now. If doctors are already musing aloud about quitting, they will not stick around waiting for software that actually works the way they think.

Giving doctors more time to dictate their charts is good. Allowing more time per patient is better. And providing a scribe, a trained medical transcriber to document everything in the visit while the doctor focuses both eyes on the patient and thinks instead of hunts and pecks, is best. Health systems may be resistant to employing scribes, but the best of them already do. Scribe salaries are a small price to pay for retaining doctors for the long term.

[Photo by Joe Raedle/Getty Images]