Note from the Instructor: National Doctor’s Day, March 30

By Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC

It’s easy to pick on physicians. As CDI specialists, we joke about the physician who still writes “urospesis” in the record, or the provider who consistently answers queries with “unable to be determined.”

Sure, it can be frustrating, but, over the years, I have been privileged to work with a number of excellent physicians. Physicians who set high standards, care about patient outcomes, work long hours and make sacrifices their patients would never know about. Over the years, I met many, many physicians who were open to learning and willing to share their knowledge with others.

Physician burnout

It is a difficult time for our providers now. Dike Drummond, MD, wrote in 2015, “There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care.” In 2009, a research study concluded that one in every three physicians in virtually every specialty experienced burnout. The number increased to 46% in 2015, according to the  Medscape Physician Lifestyle Survey, at the time. Now, in 2018, the national average for physician burn out is 54%, according to the survey.

It’s a disturbing trend.

The American Medical Association (AMA) offers educational opportunities for providers and organizations related to physician burn out, recognizing the fact that this issue is not only costly but that it directly affects patient outcomes and safety.

As organizations focus on value-based reimbursement, outcomes, and patient engagement, they cannot afford to ignore the issue of physician burnout. It affects the provider, as well as the overall environment and culture of an organization. When providers are burned out, it could result in lower patient and staff satisfaction, lower quality of care, higher complication rates, and higher physician and staff turnover. This is not just a physician problem, but a problem for all who are cared for and work within our healthcare system.

CDI’s role

As CDI specialists, we review records looking for those clinical indicators to support queries to further specify a vague or missing diagnosis. We look at the evidence to support the presence of a diagnosis. Keeping the statistics in mind, consider that you likely encounter at least one or two providers a day who are feeling overwhelmed, drained, exhausted, frustrated, or ineffective in their practice. Are you seeing the clinical indicators to support the fact these providers need support? I know you likely are.

In a recent ACDIS Radio episode, we discussed an article published November 2016 by Mayo Clinic Proceedings, entitled “Executive Leadership and Physician Well Being.” This article describes physician burnout its negative effects, and speaks to the fact that the issue needs to be addressed both on the global and the local stage. It outlines nine strategies that worked in the Mayo Clinic health system. As discussed during ACDIS Radio, this article should be required reading for executive leadership of every organization. Do you communicate to management the issues related to burnout you see amongst your medical staff? Does your organization have a plan to address physician burnout?

I can’t find a cure for physician burnout, or a solution for the demands our provider’s experience today, but I can examine how I interact with them and how I support them. CDI specialists need to recognize, as we work with providers, that we are but ONE of the demands they experience. We need to be sensitive to this fact, respectful of their time and their focus, and be a voice to assist them in dealing with the daily grind of patient care.

I am grateful for the physicians I have encountered throughout my professional life and ahead of this year’s National Doctor’s Day, I want to thank them for all they’ve taught me. And I very much appreciate that they were accepting of all I could teach them. We need to communicate that appreciation in everything we do.

Tomorrow, might I suggest that you and your CDI teams take a moment to offer treats and thank you notes to your physicians. Thank them for their contributions and praise them for all they do. But remember to then bring that attitude forward to your every day interactions. Recognize your top performers, demonstrate your appreciation of their choice to work with you. We need to be respectful of their time and judiciously apply queries. We need to design systems that do not slow them down or require more effort.

And most of all, when we open the record and see the word “urosepsis,” we need to be forgiving and understanding that although the specific wording in the record is extremely important to us, for the provider the important piece is the care of that patient.

Editor’s note: Prescott is the CDI Education Director at HCPro in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, visit www.hcprobootcamps.com/courses/10040/overview.