Lol. I can tell you if you asked doctors what the biggest problem in their clinic, it’s the EMR. I can say this myself, I’ve been in healthcare for a while in various roles, and i’m not to far off from graduating as a physician.
To find out what happened overnight to a patient, I have to sift through pages of computer generated junk to find just a few things. It’s even worse in clinic, if I want to read what happened last time a patient was here, I have to sift through a note that is 50% auto generated lists of stuff to find what I really need to know: what the last doctor said the plan was for today.
They mention inbasket messages, and that’s a huge issue. Now with the rise of patient portals, patients would message now for something that previously was a visit. Only recently has there been ways to recoup this cost (not that this is appealing to most patients, who see it as nickel and diming, though I empathize, I never can get to talk to a nurse/MA at my own family doc’s clinic either).
Doctors are swamped, most of the day is charting, ultimately to appease insurance companies so that we get paid. If you’re slotted for a 15 minute visit, and I’m not out after 10 minutes, I’m going to be late to every appointment until lunch or close, then I’ll spend time at home finishing up notes and paperwork (prior auths, refilling meds, replying to messages from nurses and other clinic staff). Ultimately, for what good our regulation of healthcare has brought in the US, it remains that it is regulatory capture nonetheless. Healthcare orgs are quickly conglomerating, so the hospital, clinic, pharmacy, and insurance company are all owned by the same company. At the loss of good patient care, doctors are being removed from the equation, care is being fragmented and compartmentalized in a lot of aspects and less of our time in the day is available for patients.
What they call burnout, really is moral injury. People who go into healthcare do it because at some level, they want to help people. It really sucks when you realize 90% of your day is screwing with a computer system that seems to be diametrically opposed to letting you do your job.
I was agreeing with you for the entirety of your comment (as someone with friends in healthcare), until you said
“What they call burnout, really is moral injury”
And then I was aggressively agreeing with you. I do not hear this aspect spoken about nearly enough. I was in hospital during COVID for non COVID reasons and I remember one terrible night where there was only one nurse on the ward, when two were needed to dispense medications like morphine. I was fortunate that I wasn’t needing medication like that, but many on the ward did. The entire night, sick and injured people were crying from pain as the solitary nurse sounded increasingly desperate as she explained to them that she needed to wait until she had backup and that she had been promised (and that, failing that, help should definitely arrive with the morning shift).
Prior to that night, my opinion of that nurse was that she was the kind of unpleasant that made me wonder “why has this person gone into healthcare when they seem to hate people so much?”. After that harrowing night, I realised the depth of the agony that her job involved and the inhumanity not just for the patients who were unable to receive medication, but for staff like her too. This was during COVID, so it’s unsurprising that the hospital was struggling for staff, but services were struggling long before COVID too.
I often think about her, and what she represents; I wonder how she was when she first started the job, and if perhaps her brusque manner evolved as the moral injury wore her down and hardened her exterior.