A few weeks ago I was sitting on a plane returning from a week-long surgical shift in a town 2000 km away from home. I’m normally exhausted after a week like this, but this time I felt particularly dissatisfied. Of course, I was still able to make a difference in women’s lives, but I also noticed the moments I felt I was failing my patients were more frequent and severe than usual.
One patient came to see me to check on her vulval warts, however there was no mention of this in her medical chart. She only informed me of this after I had examined her gynaecologically.
Another patient with advanced ovarian cancer had a splenectomy a few months ago, and came to be checked if she was ready for a vaccine trial. What shocked me was that there was no mention of the splenectomy in her records. I was trying to keep cool, but too upset and not focussing properly to ask two important questions: had she received the necessary vaccinations after the splenectomy; and was she on antibiotics to prevent a potentially deadly infection?
That day, when I fell into my seat on the plane and browsed through my medical articles I came across a one-page article on doctors’ job satisfaction, commissioned by the American Medical Association.
This paper gripped my interested instantly because it 100% captured my emotions at the time. According to this report, there are three major sources of frustration in a medical doctor’s regular work environment, and I wanted to discuss them with you here.
Unable to deliver great patient care.
According to the US study, the biggest factor affecting doctor’s job satisfaction was the doctor’s perception of the quality of care delivered by the health care organisation. Being able to deliver great medical care and caring for patients to one’s own satisfaction resulted in the highest physician satisfaction. By contrast, lack of efforts to improve the quality of care on the side of the health care facility resulted in poor job satisfaction among doctors.
Electronic Medical Records aren’t user friendly.
While medical administrators who don’t have need for this software often push its use, many medical colleagues passionately hate them. The system I must use isn’t user-friendly in the slightest, and clinical patient information is extremely hard to locate. As mentioned, I mostly rely on information volunteered by patients to understand the reason they are visiting me at the clinic. Just like the patient with the vulval warts or the patient who had a splenectomy.
Administrative abuse of doctors’ time.
The third big factor putting off medical doctors was administrative burdening. In our Tuesday afternoon clinic I spend significant amounts of time completing forms for travel reimbursement, confirming whether patients can travel alone or need an accompanying person, whether overnight accommodation is required, and when the next appointment should be.
Could administration staff complete these forms? Or does it require 20 years of med school, specialist and subspecialist training to type notes into the electronic medical record? Wouldn’t it be more cost effective for an assistant to type?
This AMA study resonated with me because our US colleagues seem to share similar frustrations that I experienced during that week.
So, what can hospital administrators do for us?
To begin with, they could consider opening their institution to quality improvement programs (such as SurgicalPerformance.com) that measure clinically relevant health outcomes and seamlessly feed them back to the clinicians. It seems doctors are primarily motivated by the possibility of delivering great service, rather by income.
Think for a moment: which job would you rather accept?
The job which required you to do stupid, unfulfilling tasks and gave you no meaning, but earned you 20% more than what you make right now? Or the job that was fulfilling, allowing you make a difference in people’s lives, but earned you 20% less than today? For me, it’s a no-brainer.
The second key thing hospital administrators can do for us is offer electronic medical records (EMR) that fit in with patient flow.
Currently, most EMR systems are developed to address software developer’s needs. I am yet to see any administrative boss sit and watch me labour through the overabundance of files (both relevant and irrelevant) for patient management. We need better EMR’s, which allow us to find relevant information easily. At the moment, hospitals and software developers seem to assume I am a forensic scientist. Yes, I know all information is stored somewhere in this complex pile of information, but it’s useless to me because it’s impossible to find.
Finally, hospital administrators could equip us with the administrative support that would run hospitals cost-effectively.
A significant portion of my work in the public hospital is administration, and I’m not alone. In a recently published Medscape report, hospital-employed doctors spent significantly longer hours on administrative tasks than their self-employed colleagues. A personal secretary on an administration wage could accomplish tasks for which I am remunerated at a senior doctor’s pay level.
By contrast, in my private practice I employ two secretaries plus a practice doctor to support my work. The rule is: every activity for which attending medical school or specialist gynaecology training is not required, I will delegate. I delegate completing travel forms, sick certificates, insurance claims, requests for re-accreditation, just to name a few. I will not type, fax or forward health records. Appointments with radiology, pathology or to arrange for a colonoscopy? My staff will manage that.
I am of the belief that many of these suggestions would not only create a more satisfying workplace and improved patient outcomes, but would also achieve this that at a lower cost.
So tell me, what are we waiting for?