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Time’s Up for Physician Social Isolation

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"Dr. Tien, pick up line 1."

I did a 180 in the hallway, speed walked to the nearest phone on the wall, and picked it up. I looked longingly down toward the end of the emergency department (ED) hallway, where a small door lead to a tiny dark room: the ED Radiology reading room. I had been trying to make it down there to review my patient's x-rays for the last 20 minutes, but I seemed to be continuously pulled aside for one task or another.

Fast forward 20 years and now not only do I have a work phone that I can put in my pocket, but I also can see every Radiology image right at my work station. I still speed walk everywhere in the ED, but visits to the Radiology room have become non-existent. My radiologist colleagues have been reduced to a voice on the phone. Until last month, I didn't even know where the Radiology reading room was!

ED physicians have always been behind the 8 ball when it comes to getting to know other physicians in the hospital. We never leave the ED. We don't go to the cafeteria for lunch. When we had physician lounges, we certainly never frequented those. We work odd hours. We are usually speed walking around the ED from room to work station to room to work station for hours on end. I consider it a "win" if I got to use the bathroom AND eat during a shift. If you haven't come to the ED, I've probably never met you.

Despite this, ED physicians have probably interfaced with more subspecialists than any other group because we take care of patients who walk in with problems from all over the medical spectrum. We also rarely can complete the full course of treatment or evaluation in the few hours we have in the ED and need to make sure that someone else takes over our patient's care once they leave the ED. As a result, I know a lot of names of physicians, have heard a lot of voices, but rarely know anyone by face. I once identified a radiologist while standing in line during one of my rare visits to the cafeteria after reading his name on his white coat. It was a moment of "you DO exist!"

The modernization of medicine has made the ED physician experience a more common experience for all doctors. What used to be medical care provided by an individual doctor is now provided by a team of doctors, advanced practice providers, case managers, and nurses. The doctor taking care of you in the hospital is not likely the same doctor taking care of you in the office. Doctors have had to become experts in data entry in the electronic medical record (EMR). It's not just about the SOAP note anymore. You don't actually have to grab a physical chart at the nursing station to enter or read medical notes. Now it's endless pop up boxes asking me to click additional boxes to measure a never-ending, constantly-changing list of metrics. The physician's responsibility to enter orders for medications, labs, imaging and nursing instruction into the EMR. Primary Care doctors are now spending over half of their day in the EMR, which means time spent in front of a computer in an office alone. If you're glued to the EMR, you're not interacting with your patients, peers, co-workers or family.

What does it matter? It matters because the social isolation of medicine contributes to physician burnout. Burnout can be described as a combination of the following: (1) emotional exhaustion where the physician feels overextended and emotionally and physically depleted; (2) depersonalization where the physician feels cynical and responds to people in a "negative, callous or excessively detached" way; and (3) a feeling of low personal accomplishment where the physician feels incompetent, that she hasn't achieved anything or been productive at work. Basically at the end of the day, you feel like you have nothing left to give. You feel demoralized.

Physician burnout has been linked to higher rates of depression, substance abuse and suicide among doctors, increasing numbers of physicians leaving medicine, and worse patient care and outcomes.

Recognizing that physician burnout is a big problem is one thing, but addressing that problem is another. Our hospital has tried to address burnout by helping physicians become more connected to each other. Some are participating in a course on reducing stress at the individual level by discussing meditation and writing as stress outlets. Another initiative focuses on getting small groups of physicians together for dinner once a month. The hospital has tried to resurrect the notion of a physician lounge where doctors can take a moment out of their day to interact with each other. (Do we even know how to do this anymore?).

There is no panacea. Many factors that contribute to our well-being as physicians are not within our direct or immediate control. (Raise your hand if you would toss the EMR metrics or requests for pre-authorizations out the window right now if you could). However, interventions that work to re-create the physician collegiality we've lost have been shown to be beneficial in reducing physician workplace stress. Even without the studies, you know that talking with a trusted friend or family member about your daily stresses of getting the kids to school on time or trying to eat healthier or exercise more or taking care of ill or aging loved ones has helped to alleviate the emotional burden of life responsibilities, right? Why wouldn't this apply to our work too?

A few months ago, two colleagues from our hospital ED and Radiology physician groups had an epiphany and took the time to organize a "hey, we should actually get to know each other in person" social mixer away from hospital grounds and work. It was cold, dark and after a long day at work, but people made the effort and showed up. We sat down and talked about ourselves, our families, hobbies, and our jobs. It reminded me of when I used to actually talk to a radiologist in-person while reviewing images on a big, rotating back-lit board with hundreds of X-rays or series of CT images hung on it. It was cumbersome and inefficient, but the face-to-face contact made medicine feel more like people working together and less about data entry and virtual conversations through cyber space. It made me feel like we were in this together and made going to work each day easier.

I've felt the same way as I'm sure many of you have. Mediation, yoga, and free pizza don't solve anything. The reasons behind my feelings of burnout go so much deeper than that. Sometimes it feels like the solutions to burnout are so unattainable that the easiest, most sane thing to do is to leave medicine all together. But then I stop and think about why I became a doctor and how meaningful our work really is. Maybe we shouldn't throw the baby out with the bath water. Maybe we should work on bringing humanity back to medicine by nurturing our doctor to doctor relationships.

It won't fix everything, but getting to know each other and rebuilding a feeling of community is something we can each work on today. And maybe our strengthened physician community will be more effective in advocating for ourselves down the road to turn the tide of health care toward something that better serves the patients and their doctors.

Dr. Irene Tien is a board-certified Emergency Medicine and Pediatric Emergency Medicine physician who has been striving for 22 years to cultivate her empathy and provide the best medical care she can for her patients. She runs the blog My Doctor Friend.

Dr. Tien is a 2018–2019 Doximity Author.

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