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2023 LMS Essay Contest: Active Physician Category 2nd Place

Has the Current Practice of Medicine Made it Easier or More Difficult to Foster Physician-Patient Relationship?
By Asha Shenoi, MD, Dch, FAAP, FCCM

Dr. Asha Shenoi is an Associate professor of Pediatrics, Division of Pediatric critical care and Assistant Dean, Clinical Learning Environment for Graduate Medical Education at the University of Kentucky. Dr. Shenoi’s research interests include Physician wellbeing, ICU quality and safety, and critical care education initiatives in resource-limited settings. She serves on various national task forces including the Society of critical Care (SCCM) Council, ACGME DEI Forum, ACGME Wellbeing forum, and is one of the co-founders of SCCM wellness knowledge interest group. She lives in Lexington, Kentucky with her husband and daughter.

How do you do it? This is a question that I get daily. I am not a fan of this question as it makes me defend the beauty and meaning of my profession, but it does force me to ponder how healthcare providers navigate the cumulative stress and the pace at work and adapt to the ever-changing healthcare landscape with more regulations and requirements piling up on them. Then I ask myself. What got you through the last 10 years as a pediatric intensive care attending? There is not an easy answer to this, but my anchoring force has been the connections with my team and the patient’s families. Building strong relationships with colleagues and patients’ families have provided a sense of community and purpose, which helped me navigate demanding and difficult situations. This has been a slow but steady process woven in by multiple small and large, intentional and personal interactions with my patients and team members. Lately though I feel the thread of connections starting to fray due to the ever-increasing demands on my time. The current practice of medicine has made it more difficult to foster meaningful physician-patient relationships in many ways, but the main impositions on physicians’ time are the documentation burden and the push for productivity.

Healthcare providers face tremendous pressure and responsibility daily making it difficult to find ways to manage their stress and stay focused on their purpose and meaning. During the covid-19 pandemic, technology transformed patient-physician interaction in many positive ways by Increasing accessibility, enhancing communication, and patient education, but excessive reliance on technology in healthcare has led to depersonalized approach and a loss of human connection and personal touch. Patients often feel like they are interacting with machines instead of real human beings, which has led to feelings of alienation and dissatisfaction. Electronic medical records(EMR) and telemedicine have made healthcare delivery more streamlined and accessible by improving communication and coordination of care, but they have also created a sense of disconnect between the physician and the patient. Physicians often face a significant time burden when it comes to using electronic medical records. EMRs are designed to improve patient care by providing physicians with quick and easy access to patient information, but the reality is that many physicians find themselves spending more time dealing with the technology than actually caring for patients. It is estimated that a physician practicing in ambulatory care settings in the United States spent an average of 16 minutes per patient encounter in EMR on documentation, orders, and chart review. So, a physician seeing 20 patients per day is spending at least 5 hours per day interacting with technology at the cost of meaningful, face-to-face connections with patients.  Paradoxically, patient-centered care which means that physicians are required to take the time to listen to their patients and involve them in their care, is being focused on and highlighted by healthcare organizations and governing bodies. Physicians are also evaluated on patient satisfaction scores and some organizations use patient evaluation as  metrics for reimbursement without providing adequate support and resources for physicians to spend face-to-face time with patients, a key factor shown to improve patient satisfaction, outcome, and compliance to care plan. The constant  feeling of being pulled in many directions and multiple micro insults fueled by thousands of daily suboptimal EMR interactions results in downstream effects of psychological distress, professional dissatisfaction, burnout, and ultimately subpar patient-physician interactions and relations.

In current physician compensation models, many physicians feel that they need to prioritize Relative Value Units (RVU)generating tasks over other important aspects of patient care, such as spending time with patients or providing thorough assessments. RVUs can contribute to burnout in healthcare professionals by creating pressure to meet productivity targets and increasing workload thus further compromising the time spend on meaningful interactions with patients. Additionally, the increasing pressure to meet productivity goals can create a sense of competition among physicians, leading to feelings of isolation and decreased teamwork. This can further exacerbate burnout by reducing social support and increasing stress levels.

In summary, the current practice of medicine has made it more difficult to foster meaningful physician-patient relationships due to increasing demands, documentation burden, and productivity pressures. The excessive reliance on technology in healthcare has led to depersonalized approaches and loss of human connection. Physicians are spending more time dealing with technology than caring for patients, which can lead to feelings of burnout and dissatisfaction. As we are moving to a post-pandemic world, incorporating the lessons learned, and bringing back the personal touch to strengthen the patient-physician interactions. Healthcare organizations need to prioritize patient-centered care over productivity targets and provide resources and support for healthcare professionals to manage their workload and stress levels. It is also important to improve the usability of EMR systems and provide training and support to help physicians use them more effectively and efficiently. By focusing on the positive impact they can have on patients and families, physicians can stay motivated and engaged and find meaning and purpose in their work.