reader comment on healthcare worker burnout; whither primary care

 A colleague of mine sent me this email in response to my blog http://gmodestmedblogs.blogspot.com/2023/04/healthcare-worker-burnout-whither.html.  as always, i asked them permission to pass comments on.

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My colleague wrote: "It's ok to send around but I think better to say 'note from a colleague', since it mentions the corporation and I'm not yet ready to be 'asked' to retire.  I don't usually feel the need for this but such is the times.   The leadership can be pretty autocratic, coming around to update us and ask for our thoughts but they've come down hard at times on those who voice criticism in these forums." 

Thanks for this review on burnout.   
Here's the short version of my response/rant :)
You've probably heard of "If I Betray These Words" by Wendy Dean, about moral injury in medicine?  I heard her speak on WBUR and also have read and heard Eric Rheinhart (NYT op-ed and a youtube interview) on the subject.  At Atrius, now part of Optum, the [health care] corporatization is increasingly apparent and frustratingly making practice a game of work around and resistance.   Our leaders, though MDs, are now also MBAs who have destroyed a cultural working system of relationships and focus on patient care.

Large pools of people answering phones, making appointments, large pools of nurses giving advice, no one knows the patients and families, no one knows how we practice, which families need certain approaches and time frames for appointments and that we can 'fit in' patients if need be,  We can't fully accommodate or be responsible for our patients because there's no flexibility or communication.  We are truly now cogs in the wheel. 

 In order for specialists or patients to reach us directly, it's now best to give out cell phone numbers so they don't encounter hours or days of waiting until we get the message.   

Most ironic and infuriating is after destroying the relationships we have with our staff, they have instituted what is being called 'relational coordination', the 'hypothesis' being that if people know each other, they will communicate better. (!).   One of the MD admins is collecting surveys on this to use for his masters thesis.  Ugh. 

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By the way, my colleague did send me this video of Don Berwick giving the keynote speech at a recent conference of the Institute for Healthcare Improvement (https://www.youtube.com/watch?v=eErdxYZ7BSM&ab_channel=InstituteforHealthcareImprovement-IHI ).  his speech brings up many of the same issues we are all dealing with: healthcare worker burnout, difficulties in functioning in primary care, and the perverse monetary issues in our health care system for us and for our patients.  

geoff

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