Physician Burnout! A disturbing trend

Burnout1

Since my last post about my late Grandfather, I didn’t have the motivation to write; but then I thought about all of the times he encouraged me to write, it reminded me to follow my passion, so here I am with my thoughts again, this time on the disturbing trend of Physician Burnout.

Physician BurnoutOver the last 7 years since the time of the “Great EMR Implementations”, we have always discussed physicians retiring because they did not want to learn technology and use the EMR. I put it down to older physicians not keeping up with the times. I’m not so sure about that anymore.  The reason being that one of my friends who is a physician went through a very visible burnout episode that surprised everyone recently. She said that she was working until the middle of the night trying to keep up with documentation and it finally became too overwhelming for her to take. This surprised me tremendously. This wasn’t something that happened to younger, more savvier physicians…or so I thought. IBurnout2n a June 29th, 2017 article in the Harvard Business Review, points such as loneliness at work is also a factor that is identified as the reason for burnout (it doesn’t discuss physician burnout in particular though). Similarly, in a June 22nd article in Time Magazine, titled “Doctor’s on Life Support”, it starts by saying that “Doctors are stressed, burned out, depressed, and when they suffer, so do their patients. Inside the movement to save the mental health of America’s doctors“. The  signs of stress are evident. IT departments can and should do more to collaborate with clinic practices and primary care and specialties to help develop efficiency within the every day use of technology. Technology “A-Teams” should be identified to work with their physicians, understand the challenges that they are facing, whether in the EMR, wireless “dead zones” in clinics that drop the connection, old laptops and PCs that need to be updated, that sometimes may mistakenly be attributed to an EMR deficiency or other areas where the process can be smoother for the physician and/or clinic staff.

All of us as Healthcare Information Technology professionals needs to bear in mind that we need to do all we can do reduce and eliminate physician burnout and improve the processes for the physician so that we can enable them use technology for better, faster and more efficient patient care. The burden of EMR documentation should be lessened and, at the end of the day, it will be the patient that will gain and the quality of care will increase with a happier, less stressed, care provider.

 

Be Bold! Life and Lessons from my Grandfather 

My Grandfather, K.R. Chandrasekhar (whom I, like many of South Indian descent, called Tata, meaning Grandfather, pronounced ‘Tha Tha”)  was born a few years after World War 1 in July of 1922, in what was at that time part of British India.  World War 1 saw many things happen in India from the early independence movement as well as many as 1.5 million Indians being drafted and 75,000 giving the ultimate sacrifice with their lives defending the British Empire against the Central Powers. Understanding the time that he was born, is instrumental in getting an idea of what India was like then. From his humble roots in a little village, about 40 miles north east of the present day town of Bengaluru (aka Bangalore) of the then Kingdom of Mysore, to his days in insurance sales from the 1950s  onwards around the country, his was a life of hard work and sacrifice that he never let me forget. He went to different people’s houses to eat every other day and had a tough life until he was a young teen. Getting the ability to study, changed his life. A good education has been ingrained in every Indian parent’s life from as long as I can remember. That’s how, from close to poverty, he went to St. Joseph’s College in Bangalore and married my Grandmother in 1942. My Mother was born soon after in 1944 and another son, born later that decade, sadly passed away due to a medical error by the late 1940s.

My Grandparents went on to have 2 other children; two sons, my uncles in the early 1950s and that was his family after that. The story of how Tata ended up going into accounting versus engineering is an interesting one.

It was late 1930s and he was cycling down a road in Bangalore called JC Road on his way to pay his college fees to go to engineering school as it was the last day to pay. In the distance, a car was driving towards him. Thinking the driver would avoid him as he got closer, Tata continued cycling. He then realized that the driver (an Englishman who it later turned out was the Commissioner of Police who was drunk after an afternoon of heavy drinking) was swerving left and right and hit and ran over Tata. My Grandfather told me he remembered the wheels of the  car on either side of him as he went down and his bicycle getting crushed. The driver, realizing what had just occurred, stopped, got down and proceeded to get Tata into the car and rushed him to Victoria Hospital; where he paid his hospital bill in advance and left the scene (not wanting to be around due to his position). There my Grandfather lay for 3 days unconscious. On the 4th day he opened his eyes and his brother, who had walked from their village north east of Bangalore was sitting in front of him and said “We were wondering where you were. I searched everywhere and someone said that you had been admitted here so I came. Looks like you are ok, so I’m off!” and he left to go back to their village.

My Grandparents and their young family in the 1950s

In any case, Tata was now in a dilemma. Colleges had closed payment of fees for engineering and he was at risk of missing a year when someone told him that there was still a college in the next kingdom that was available and they had not closed admissions or payment. The only problem was that it wasn’t in Engineering, but a Bachelor of Arts in Economics. My Grandfather thought “Well, one degree is as good as another!” and off he went to start his Bachelor of Arts degree instead of an engineering degree!

From there, he came to Bangalore after one term and ended up getting a seat at St. Joseph’s College. After completing his Bachelor’s of  Arts in Economics, he was interviewed by the local commander of the British garrison to be an auditor for their Bangalore region during WW2; the Commandant didn’t need a person with a degree even though Tata had one “As long as you understand book keeping, that’s all I need”. Landing the job, he then set out to audit the some of the billions of pound that India sent in war material and treasure to the British homeland and the war effort to defend and fight against Hitler and the Nazis (he also mentioned that because he was able to go on the base, people would ask him to get them whiskey and brandy as it was subsidized for the military and he could come back with cases of liquor to share with relatives and friends, something he told me with amusement some years ago).

After World War 2 ended and his work with the military was complete, he briefly got into the restaurant business, but at that time, caste and community played a big role in Indian life as he was chided for being a “brahmin” starting in the restaurant business and that too with the education that he had received, was apparently supposed to do more with his life than just being a ‘lowly’ restauranteur. Unhappy with the criticism of his entrepreneurial pursuits, he left that business in the late 40s and was able to go into life insurance sales with the then Oriental Insurance.  This was his calling and he was as passionate about his job (as I think I am for my work in healthcare) and spoke endlessly about it years after his retirement.

The coolest Uncles a boy could have

In the late 1950s, my Grandfather enrolled my uncles in a boarding school around the ages of 7 or 8. (I speculate) Tata did not want their lives to be disrupted whenever he had a new assignment (though he lived 15 to 20 minutes away from them the first few years they were there) and was posted to a new position. My surviving Uncle shared with me that it felt like being put in jail by my Grandfather, but he’s gone on to be a senior executive of a few companies and I credit Tata for giving him a good foundation for much of his success and harnessing his natural talents, even though my Uncle may think otherwise ( after his undergraduate degree, Tata told him that he had called his accountant friend in Bangalore and my uncle will go work for him as an article clerk in his accounting practice; saying no to my Grandfather was not an option).

My parents soon after their they got married

I find it interesting that Tata kept my Mother with him and not in boarding school like his other two children, two sons to live a very disciplined, boarding school life also gives us insight into the sacrifice of not having his two boys with him by his side during their formative years, especially since he had already lost one son in his life by then. Later in life, he relied on his youngest son more than anyone else after losing his older son to kidney disease in the early 2000s.

My parents were married in the late 1960s. Both of my sets of grandparents knew each other and as was the custom, it was an arranged marriage within our community; a “Ashtagrama”  or “8 villages” community. One of the biggest responsibilities for fathers of daughters in those days was to make sure that he got them married into good families. Both of my grandparents were of good reputation and it was in this light that my mother’s father was able to fulfill one of his life’s obligations. My Uncles were married in quick succession some 8 years later.

Tata and I

He retired as the Divisional Manager for the Southern Region of the Life Insurance Corporation of India in 1985. After my own father passed away when I was a teenager, my Grandfather took us in 1987. Two years after he had retired, he had to take on a new set of responsibilities of his daughter and her two children who had never lived in India, didn’t know the language and customs and were emotionally disconnected from the loss of their well set lives overseas.

He had a never give up attitude. He instilled in me a sense of loyalty to family, reminded me that he came from poverty and he had worked hard to get to where he was. He gave my mother the confidence she needed to get through life without her husband and gave us all inspiration with his stories of the 1920s, 1930s and much of the 20th Century (one story he narrated was about how he was chased by a monkey in the temple town of Tirupathi in the 1920s. When I asked him how he was able to remember an event from the 1920s, his reply was simply; “If you were chased by a monkey, you’d never forget!”)

Persistence and the ability to endure was a hallmark he had. Having lost a child (a son) at a young age of 1 or 2 in the late 1940s, a son in law 31 years ago and then another son a decade ago, many would have grieved and wallowed in their plight. Not my Grandfather. Having faced difficulties throughout his life (he nearly drowned in a well, fallen out from trees numerous times at a very young age and could have left this world on a number of occasions in his youth) his continuous attitude of “Be Bold!” was something that I have continued to carry with me when I need it the most.

In June of 2016, my Grandfather suffered a heart attack and was an inpatient on a ventilator for 21 days in Bangalore. At some point, he could not stay on the ventilator indefinitely and his physicians said that when they took it out and he had trouble breathing, he would need a tracheotomy . After consulting with my family, the doctors were ready to perform the surgery the moment they removed the ventilator. My Grandfather, not one to go that easily and having practiced yoga for 70 years of his life, immediately started the “pranayama” breathing techniques in yoga that he had been practicing most of his life. He slowly began breathing on his own. The doctors were amazed at his endurance and at that age! No medicines, no technology. It was all him! He came home a few days after and when he got on the phone with me, he excitedly exclaimed to me”94, NOT OUT!” At the age of 94, he was still around as my Tata!

He was disciplined with all of his accounting and remembered his bank account numbers until the very end of his life (I’m lucky if I remember what happened yesterday!) The way he kept all of his documents was an amazement to all and he was a excellent document manager.

Prior to leaving to the United States for graduate school for my MBA in the mid 1990s, I had to go and ask my future father in law for my girlfriend’s (now wife’s) hand in marriage. I remember being with my Grandfather before I drove across town and sensing my nervousness he came up to me and said ” Be Bold!” Two words he would speak often to all of us.

While this blog post details his life more than anything else and departs from my discussion of healthcare, as an amateur historian and a grandson to an amazing man such as my Grandfather, I felt it both a privilege and duty of mine to share some of his story with my family, friends and readers of my blog. Hopefully you enjoyed reading this snippet of his life story as much as I have had in writing it.

My Grandfather was 3 months and two weeks shy of his 95th birthday and 6 weeks shy of his 75th wedding anniversary when he breathed his last during the early hours of March 27th, 2017. After a, many would say, full life of 4 children, 6 grandchildren and 6 great-grandchildren, he finally left us. Even in death, Tata wanted to make a difference. Ever the practical man he was and not one to go by convention or tradition, his was the first I’ve ever heard of a person in my family donating his body to science, something that he had apparently wanted to do since 1980, but wrote as his last wishes in December of 2015. Making a lasting impact on medical students to learn from him even a year after he left this world. That’s why I loved him so much. My Grandfather, K.R. Chandrasekhar was simply put, the best of all of us.

 

 

The American Health Care Act 2017

I was chatting with my colleague Scott Mash from the CSO HIMSS Board on the way to work this morning and we were talking about how all of the successes we have had over the last 5 to 6 years on improving interoperability across the healthcare landscape in the United States and Meaningful Use could all be in jeopardy with the new healthcare law currently being proposed by The White House and to be voted on in Congress this week. The American Health Care Act in consideration will have a direct impact on the lives of all of the patient population across the healthcare spectrum. Healthcare providers across the United States are strongly lobbying that the proposal be changed and significantly improved so that it can protect health care access for many individuals nationwide.

The proposed act puts the healthcare benefits of around 14 million individuals, that depend on Medicaid for health coverage into ambiguity; a tentative roll-back of Medicaid expansion in several states and differences in how the US government will assist the states to pay for Medicaid, will mean that each state may have to bear the brunt of these cut backs with potentially less federal subsidies coming in. This means that states such as my state, “The Great State of Ohio” will have to reduce payment rates, patient eligibility or patient benefits in order to cover the shortfall.In addition to Medicaid coverage losses, employer coverage could fall by as much as 7 million. Patients who might have otherwise had employer-sponsored insurance would transition to the individual market or become uninsured.

Beyond the increase in the self-pay patient population, many individuals may have extremely high deductibles that would make their healthcare insurance coverage unaffordable to them. This information is going out to many within healthcare providers. I was able to get some of the information for this blog post from other people that I know and do not claim to be the originator of this blog post information.

While there is no silver bullet to achieve healthcare benefits for all, the answer is not to roll back the successes we have seen over the last decade; the opportunity for us now is to build on the achievements we have made and improve how we can achieve better patient outcomes for all. Let’s continue to improve and not roll the clocks back.  

PS – The inspiration for this blog post was when Scott and I ended the call with “Holy Toledo! To the Blog Cave Batman!”

 

2016 – The year of Disruptive Living

With 2016 behind us, it’s hard to believe we somehow survived this year. Whether we admit it or not, we’re not used to big changes and politics does play an important part of our lives. Whether it’s in that realm or in technology, we are creatures of habit and rarely like our world or ecosystem to change. The biggest challenge I’ve always encountered on a project is change; whether it’s process or technology changes, it’s always a challenge to get people to change and adopt a new way of working. Physicians are particularly challenging to change as they are very set in their ways.

Whether it’s the elections that occurred that seemingly swung the pendulum a different direction than what was in motion for the last 24 years or the endless march of technology like Amazon Go, (which I believe could have applications outside of Retail such as in Healthcare), our lives have been greatly disrupted as we see that the status quo is not acceptable anymore.

I’ve been asked by a few people whether MACRA will get scrapped under the new US administration or whether some of the current other reporting requirements will be changed. Currently the view has been only time will tell as there has been no specific policy that has mentioned anything one way or another. Will much of the work accomplished or investment over the last 5 years be set aside or will we be able to build off that and leverage this paradigm shift for the greater good?

Only time will tell. Whatever it is, there are many people that would like to see 2016 into a distant memory and hope that the new year brings with it better fortunes than the current one has dealt many.

In Memorium: Carrie Fisher aka Princess Leia (1956 to 2016)

“Help me Obi-Wan Kenobi, you’re my only hope.”

Are EHR vendors becoming Population Health corporations?

An interesting article surfaced in Healthcare IT News that suggested that executives at some healthcare software vendors want to transform themselves from generically being deemed as an EHR vendor and become a Population Health company like Cerner’s CEO Zane Burke told Healthcare IT News. 

Being able to access data relevant for patient care should be possible regardless of the format it is presently in or whether it is in an EHR,  national database or in pdf format. 
The constraints that “EHRs” are presently may not allow for this functionality  (yet). The article goes on to state that providers are also moving towards precision medicine, accountable care management, chronic care management and value based reimbursement. 
Movement for many on the ground is still in the initial stages and only those provider organizations with deep pockets and the ability to leverage collaborative working relationships with solution vendors can think about moving forward with all of the initiatives mentioned above in a meaningful way.