On Physician Burnout and the Plight of the Modern Knowledge Worker

November 7th, 2018 · 19 comments

On Screens and Surgeons

Atul Gawande has a fascinating article in the most recent issue of the New Yorker about the negative consequences of the electronic medical records revolution. There are many points in this piece that are relevant to the topics we discuss here, but there was one observation in particular that I found particularly alarming.

Gawande introduces the Berkeley psychologist Christina Maslach, who is one of the leading experts on occupational burnout: her Maslach Burnout Inventory has been used for almost four decades to track worker well-being.

One of the striking findings from Maslach’s research is that the burnout rate among physicians has been rapidly rising over the last decade. Interestingly, this rate differs between different specialities — sometimes in unexpected ways.

Neurosurgeons, for example, report lower levels of burnout than emergency physicians, even though the surgeons work longer hours and experience poorer work-life balance than ER doctors.

As Gawande reports, this puzzle was partly solved when a research team from the Mayo Clinic looked closer at the causes of physician burnout. Their discovery: one of the strongest predictors of burnout was how much time the doctor spent staring at a computer screen.

Surgeons spend most of their clinical time performing surgeries. Emergency physicians, by contrast, spend an increasing amount of this time wrangling information into electronic medical systems. Gawande cites a 2016 study that finds the average physician now spends two hours at a computer screen for every hour they spend working with patients.

Incomplete Solutions

Electronic medical records present a complicated case. As Gawande emphasizes, this technology undoubtedly represents the future of medical care — it solves many problems, and going back to ad hoc, handwritten systems is no more viable than the acolytes of Ned Ludd demanding the return of hand-driven looms.

The solutions Gawande outline include two major themes. The first is making these systems smaller, more agile, and more responsive to the way specific physicians actually practice, instead of trying to introduce massive, monolithic software that generically applies to many different specialities.

The second theme is introducing more administrative help to mediate between the doctor’s clinical work and interactions with the electronic systems (e.g., my recent article on intellectual specialization).

What caught my attention as I read this article, however, is that many knowledge work fields have experienced a similar shift where individuals now spend increasing amounts of their day interacting with screens instead of performing the high-value activities for which they were trained (just ask any professor, computer programmer or lawyer).

For us, it’s email and instant messenger instead of electronic medical systems, but there’s no reason to believe that the effect wouldn’t be the same: more ancillary screen time produces less well-being and, eventually, more burnout.

In the rarified and focused world of medical care, there are solutions to this screen creep problem. But where are the solutions for the rest of us? This is arguably one of the biggest problems facing our increasingly knowledge-based economy, and yet few currently take it seriously.