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Should patients bail out when their doctor is burned out?

Should patients bail out when their doctor is burned out?
Author Information (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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Google “physician burnout epidemic,” and you will find quite a few articles and blog posts on the subject. By all accounts, physician burnout is getting worse.

Causes are many, including job dissatisfaction, loss of control, work-life imbalance, tuition debt, government and insurance regulations, electronic medical records, and more.

Solutions are few, and not many have been validated.

The emphasis has been on the plight of doctors, but what about patients? Doctor burnout has been associated with suboptimal patient care.

Neurologist John H. Noseworthy, President and CEO of the Mayo Clinic, has a suggestion—fire your doctor. In an interview on Chicago’s PBS outlet WTTW, he was asked what patients should do if they think their physicians may be burned out, cynical, or not empathetic.

He replied, “I think the first thing is to recognize it and change physicians. Candidly, it is too risky to be cared for by someone who is impaired. It is difficult to say that but it is true. You can say, ‘Doctor, you used to be a great doctor. You used to care about me. You seem different. I hope you are getting some help.’ But in the meantime, patients and their families have to look after themselves.”

In answer to a follow-up question, he said it might be helpful if patients told their doctors why they were being fired.

Dr. Noseworthy’s advice is problematic because the average patient would neither be able to diagnose burnout nor be willing to confront a doctor with suspicions of burnout.

Even more importantly, how easy would it be to change doctors? In late 2015, a survey by investigators from the Mayo Clinic found the following:

Of the 35,922 physicians who received an invitation to participate, 6880 (19.2%) completed surveys. When assessed using the Maslach Burnout Inventory, 54.4% (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.5% (n=3310) in 2011 (P<.001). [Emphasis added] Satisfaction with work-life balance also declined in physicians between 2011 and 2014 (48.5% vs 40.9%; P<.001). Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.

Based on the Mayo Clinic’s own study, a patient who decides to change doctors has a better than 50-50 chance of ending up with another burned out doctor.

Is it worth taking that chance?

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

5 Comments

  1. Not the same, but I also once had a vet I should have left sooner than I did (a more perceptive friend did switch). He got diabetes and became so mentally preoccupied with that that he wasn’t as good a vet. He ended up retiring and focusing on his health.

    Of course if it is one visit you just figure the excellent doctor or vet isn’t up to snuff that day or for a period, but if you notice something continually, it’s unfortunately time to go.

    Reply
  2. I have to agree, it is worth it if you detect your doctor has changed. He wasn’t my doctor, but a well-known and respected doctor who had a tremendous reputation and who helped my neighbor with numerous conditions changed during the last couple years of his career and was not the same (and he sort of milked his last patients by changing to a concierge practice but then not being available or being even on a par with before).

    But no it’s not easy at all to find an excellent new doctor. It’s a time-consuming pain in the neck. Nonetheless, if you don’t change when you detect this, you run the risk of regretting that you didn’t mightily if you suddenly should fall ill.

    Reply
    • As I said, you have about a 50-50 chance of getting another burned out doctor. I guess that’s better than 100% burned out if that’s your current situation.

      Reply
  3. It is worth it. My mother was very ill with CHF and pneumonia last year and her GP of some 20 years, while stopping at the nurses desk to look at her charts, never even bothered to come in and talk to mom. She decided mom’s sodium level was too low (hello – CHF – on diuretics – it’s going to be well below normal!). She was determined to get that number up to 136 – by taking her off all diuretics and limiting her to 1 liter of water a day. (A kidney doc later told us her sodium level of 124 was sufficient given her condition.) Mom’s leg swelled up so much it looked like she had elephantitis! I called the docs office 3 times over 2 days and got no call back. After telling the RNs looking after mom that this was NOT acceptable, they contacted her office and insisted she come in. When she did, she barely looked at mom’s leg and mostly berated my sister and I for bringing mom “ensure” type drinks (mom was on NO sodium food and wouldn’t eat it because it tasted so bad). We said she had to get nutrition and I wasn’t happy with the course of treatment she had mom on. After that meeting I called mom’s medical group and talked to someone in charge and said in no uncertain terms that this doctor was not welcome to continue treating mom and I requested a younger doctor we had met when mom’s GP was out for a week. They made it happen and the young doctor came in that same night after seeing all his other patients and spent time with mom – assessing her condition – and put her back on diuretics right away. Believe me, when you’re advocating for a loved one, don’t be afraid to question the doctors about their treatment!

    Reply
    • Glad you were able to change doctors. It’s not easy. Diuretics are necessary in patients with HF but a sodium of 126 is dangerouslying low. Sodium is necessary as is potassium and magnesium. I hope the new doctor has corrected that problem.

      Reply

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