Physician burnout is on the rise. I’ve seen statistics that claim at least one symptom of burnout in 46-54 percent of doctors. Critical care and emergency room doctors experience the most, according to one Continuing Medical Education report I read. The symptoms of burnout include emotional exhaustion, depersonalization (the sense of not being completely present), and a sense of reduced personal accomplishment and quality.
And, the numbers are rising. Only 13 percent of doctors reported burnout in 2013, but that number rose to 46% in 2015. The most recent issue of Psychiatric News asserts that burnout has grown to 54 percent this year. Obviously, it also affects patient safety.
The primary reasons include excessive productivity quotas, limits on the time doctors in all specialties can spend with each patient, and documentary requirements. The president of the American Psychiatric Association (APA), Anita Everett, MD, is inviting psychiatrists to provide feedback about burnout, so that causes can be addressed and perhaps ameliorated.
Well, I have lots of feedback, but she probably doesn’t want it. Let’s just say I retired because practicing psychiatry was ruining my health. Seeing patients was the easiest and most enjoyable part. My greatest stress came from the criminally abusive health scare/snare racket that grinds human beings up—patients, staff, and doctors—and serves them up to absentee bosses for unearned profit.
Who are these absentee bosses? In short, they are everyone except the patient in the room. The patient in the room is at the mercy of the insurance companies, the pharmaceutical companies, the government, lawyers, and everyone who stands to benefit without risk from the doctor-patient interaction. For a patient to see her own medical records, or her bill, requires formal written requests, and even then she must often wait or receive only partial information.
As a “provider” I opted out of Medicare, because it didn’t allow patients to do their own billing. For patients to do their own billing is an important therapeutic tool, as it empowers them to become involved in the decision-making process, to review and sign off on diagnoses, treatments, and to decide how much confidential information to share with people outside the room. I did not make this up. I learned in psychiatric residency that people tend to appreciate what they must pay—or at least work--for, and they tend to get more value for their treatment and their money. No one seems to understand or remember that Medicare is not health care but health care insurance. Medicare is a guaranteed insurance subsidy, primarily for Blue Cross.
Obamacare, or the Affordable Care Act, expands the mandated insurance net to the entire population. It is a case of Congress practicing medicine.
Congress is composed of about one-third lawyers. The 115th Congress of 2017 has 15 MDs, three of whom are in the Senate. It is considered medical malpractice for doctors to treat patients they have not personally seen. What if the absentee treatment providers are not doctors but insurance company “utilization reviewers,” or members of Congress? Could they be sued personally for medical malpractice, just as doctors are?
If we have human rights, certainly one of them is the ownership of our own bodies, at least since slavery was abolished. The mandate for individuals to purchase pre-paid medical treatment of a specific kind—allopathic medicine is only one of many approaches—is a human rights violation of the most egregious kind. So are drug laws, for the same reason, but the precedent for drug laws was set with the Whiskey Tax in 1791. The US Constitution, which presumes all taxpayers are federal government property, makes no provision for health care, health insurance, or drug laws.
The reason we have physician burnout, according to me, is that doctors are wimps. While they presume to treat patients, they spend most of their time treating the system, the medical records, and the absentee bosses. The patients suffer from the distractions, and they blame the doctors. Confidentiality goes out the window when everyone who controls a piece of the check has access to the record. Records are skewed to fit diagnosis codes, insurance codes, and payment codes. The patient is skewed to fit the record.
The “health care industry” was already changing rapidly when I graduated from psychiatry residency. An onslaught of new, patented (read “expensive”) prescription medications was beginning to come down the pike, and they were being marketed directly to “consumers” over television and other media. In the mental health field, psychotherapy was being shifted to the less expensive psychologists and social workers. Psychiatrists became marginalized into “medication managers,” or prescription-writing machines, because of insurance requirements.
Did anyone go to bat for the patients who also had medical problems, whose psychiatric problems may be at least partially the result of those? Did anyone think that the “brain-body connection” applies to everyone who has a neck, that the head is connected with every part of the body through the nervous system? Did anyone point out that the doctor-patient relationship is a personal bond that in the past was maintained over years and generations? What if your doctor is “out-of-network”?
Does the AMA or APA speak for common sense and the dignity of patients and their doctors? Well, the professional journals are dominated by advertising from the pharmaceutical industry, so the focus is on medications, with a bias hard to ignore. The current trend is “integrative medicine” that involves everyone on staff in a professional gossip circle that passes for comprehensive care. There’s also a push for “evidence-based medicine,” which in psychiatry depends in large part on questionnaires and subjective measurement tools. “How many days were you depressed last week?” How many days did you drink?” “Do you ever feel life is not worth living?”
How many patients answer these questions honestly, knowing the answers will go into their records and may affect insurance re-imbursment or premium cost?
How courageous is the AMA or the APA in advocating for patients and doctors when it comes to the burdensome paperwork that consumes so much time, is generally irrelevant but demanded by the armies of absentee bosses? Why are so many doctors leaving medicine?