High-tech leaving device with fading heartbeat
CHICAGO» Two centuries after its invention, the stethoscope — the very symbol of the medical profession — is facing an uncertain prognosis.
It is threatened by hand-held devices that are also pressed against the chest but rely on ultrasound technology, artificial intelligence and smartphone apps instead of doctors’ ears to help detect leaks, murmurs, abnormal rhythms and other problems in the heart, lungs and elsewhere. Some of these instruments can yield images of the beating heart or create electrocardiogram graphs.
Dr. Eric Topol, a world-renowned cardiologist, considers the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
It “was OK for 200 years,” Topol
said. “(But) we need to go beyond that. We can do better.”
In a long-standing tradition, nearly every U.S. medical school presents incoming students with a white coat and stethoscope to launch their careers. It’s more than symbolic —
Imagine a health care system where doctors and nurses are so exhausted and beaten down that many of them work like zombies — error-prone, apathetic toward patients and at times trying to blunt their own pain with alcohol or even suicide attempts.
That is what America’s broken health care system is doing to its health workers, according to a 333-page report released Wednesday by the National Academies of Sciences, Engineering and Medicine, one of the country’s most prestigious science institutions.
The report found that as many as half of the country’s doctors and nurses experience substantial symptoms of burnout, resulting in increased risks to patients, malpractice claims, worker absenteeism and turnover, as well as billions of dollars in losses to the medical industry each year.
“It’s a moral issue, a patient-care issue and a financial issue,” said Christine Cassel, professor of medicine at University of California at San Francisco, who led the committee of experts that wrote the report.
In recent years, as the medical community has grown increasingly alarmed over the problems of burnout, the proposed solutions have focused on increasing the resilience of individual doctors and nurses. “What this report is saying is that this is a systemic problem that requires systemic solutions,” said Cassel, former president of the American Board of Internal Medicine. “You can’t just teach doctors meditation, yoga and selfcare. We need big, fundamental changes.”
The committee’s experts — which included doctors, nurses, health executives and leaders in bioethics, neurology and pharmacy — spent 18 months wading through mountains of research on clinician burnout. They found that 35% to 54% of nurses and doctors experience burnout. Among medical students and residents, the percentage is as high as 60%.
Symptoms, they said, include emotional exhaustion, cynicism, the loss of enthusiasm in their work, and increasing detachment from their patients and the patients’ ailments. The problem has been linked to higher rates of depression, substance abuse and suicide. The suicide rate among physicians, for example, is twice that of the general population and one of the highest among all professions.
Health care workers are especially prone to burnout, the report found, because of the workload, pressure and chaos in which they operate everyday. And as the country’s health care system has become increasing dysfunctional, the bulk of that dysfunction has landed on them — resulting in long hours, mounting paperwork and bureaucratic hurdles, fear of malpractice lawsuits and insufficient resources.
The problem often starts with a well-intentioned, perfectly reasonable law, explained co-author Vindell Washington, chief medical officer at Blue Cross and Blue Shield of Louisiana. That is turned into a regulation, which is interpreted and made into a policy, often taking the most conservative path possible for legal protection.
“At every step, the original intent gets a little misinterpreted or picks up an unexpected effect,” Washington said.
A law about patient priwith vacy, for example, becomes a quirk on a doctor’s terminal that ends their sessions every few minutes and makes them log in repeatedly all day long — adding frustration and burden to their days.
Complex regulations on hospital reimbursement gives rise to a long list doctors must tick through in physical exams even as they try to figure out what’s ailing a patient, so that hospitals can charge more or less based on the exam’s complexity. “The problem is we’re not workers in a factory making widgets,” Washington said.
“It’s incredibly inefficient, and the workload is unsustainable,” said Liselotte Dyrbye, a doctor and researcher at the Mayo Clinic. “The system is built for billing. and not taking care of patients.”
Burnout is also expensive. One study cited by Wednesday’s report, for example found it costs the medical system $4.6 billion a year. Some of that cost comes from doctors reducing their hours, quitting their jobs or leaving medicine altogether. With each doctor affected by burnout, the estimated average cost to the medical industry in America is about $7,600. And those numbers don’t include the costs of increased medical errors, malpractice lawsuits and other doctors’ having to pick up their burned-out colleagues’ work.
That financial incentive is imperative because alleviating burnout will require significant buy-in from federal regulators, insurance companies, medical schools and the country’s health care systems.