The medical profession is out of balance. As we have established, our medical environment is the most resourced in the world. It has the world’s best hospitals, universities and industrial capability. While hospital, university and industry leaders contribute enormous energy to the medical profession, they fall short in one category: they, themselves, are usually not medical professionals. That distinction belongs to the doctors.
Assuming that our imbalance is indeed a professional imbalance, then the doctors are the only ones that can truly solve the Medical Care Crisis. They must own it. This begins with awareness that they are the owners and that through their purposeful action, they can drive the change that solves the Crisis. We need the doctors to step up, and restore balance in their medical profession.
So, where are the doctors?
According to most reports, nearly 60% of doctors are suffering from clinical burnout – a disorder manifesting as physical and psychological exhaustion, depersonalization, cynicism and work performance decline.
In fact, poor availability, a feature of the Medical Care Crisis, is at least partially the result of clinical burnout. It is not just a numbers game. While there may be a doctor shortage, there is also a doctor engagement issue – the result of burnout that no doubt contributes to decreased productivity.
According to 3M Science, 60% of doctors cite meaningless bureaucratic tasks, including the use of the Electronic Medical record (EMR), as major contributors to burnout (the EMR cited specifically by over 50% of doctors surveyed). While it is easy to see how assigning time-consuming clerical duties to doctors stunts productivity, psychologists tell us there is a more insidious and sinister effect at play. We have created a whole generation of new doctors who have never practiced medicine without manually entering data into an EMR. They believe that their data entry, which could easily be done by a technician, is an essential part of being a doctor. We have perpetuated the false concept that completing the EMR correctly (a meaningless task) is as important as patient well-being or seeing a new patient. Decreased productivity becomes professionally acceptable.
So does clinical burnout: being chronically burned out is part of being a doctor! Really?
The key word here is “meaningless." In the 1950s, psychiatrist and Holocaust survivor Victor Frankl introduced the concept of “Logotherapy.” Frankl’s observation during his Nazi concentration encampment during World War II was that detainees who lost a “sense of meaning” in their lives almost always succumbed to death, either by disease or attrition. “A sense of meaning” yielded greater purpose and, thus, a reason to survive. It is this drive that propels us forward. While the term burnout was not part of his lexicon, Frankl was clearly referring to the same clinical condition described today. Taking this to its final conclusion, it is meaning, purpose and drive that provide the anecdote to clinical burnout. Frankl spent his entire post-war career promoting the importance of Logotherapy (meaning) for a healthy and productive life. In other words, Frankl spent his whole career treating clinical burnout. Mankind must have a meaning to survive. So does the medical care environment. Without meaning, there is no balance.
If meaningless bureaucracy is at the root of clinical burnout, then restoration of meaning for doctors suffering burnout is the pathway to its cure. It is also the pathway for rebalancing the medical profession.
As we have previously highlighted, most doctors today are employed by hospitals. With employment, doctors usually forfeit some or all of their autonomy. As we have also previously established, doctor autonomy (acting in accordance with moral duty over self-interest) is essential for balance. With the loss of autonomy, doctors have become disconnected with “moral duty,” another name for meaning. The result is disengagement. The catalyst, then, for rebalancing the medical care environment (and eliminating burnout) starts with re-engaging the doctors. If the doctors are not engaged, nothing happens.
The formula for re-engagement is shown graphically below:
The process starts with Purpose.
In this model, it is equivalent to Frankl’s meaning. It is the catalyst that starts and sustains the process. Purpose rallies teams of individuals around common beliefs. Those common beliefs constitute team Culture. Culture and Purpose combine to drive Performance. In the case of the Medical Care Crisis, Performance would include rebalancing the care environment. Experienced leaders understand the importance of the process above. Performance (or lack of Performance) always starts with the “inner game.” Purpose and Culture. Purpose and Culture are always the levers that great leaders pull to achieve results. Results simply follow suit in the form of Performance.
If we are to re-balance the medical care (professional) environment, then, the process starts with the doctors. Doctors must become owners again. That is the battle cry. That is the Purpose. That is the sense of meaning. That will motivate engagement. Doctor teams committed to rebalancing the profession will create Culture that is committed to eliminating meaningless tasks and making patient well-being the priority. Performance will follow. That’s when the medical profession will become rebalanced. It’s also when patient well-being becomes the priority and everything else becomes subordinate.