Save our young doctors

Is Too Much Technology Sucking the Joy out of Medicine?

Guest Editorial

There is a collision of cynicism and optimism in any discussion of Millennial healthcare workers.

For those who view the intrusion of digital technology into healthcare as a negative trend, Millennials, with their overdependence on technology, are part of the problem sucking the joy out of medicine. They embrace these interloping devices and systems too readily, and compromise old fashioned caregiving.

On the more optimistic side, these tech-savvy digital natives may hold the key to reconciling the potential of EHRs with their design and application. A generation of doctors who enter medicine expecting more digital support than currently exists, far from  than resisting digitization, will push design, development, and utilization further, faster, and more effectively.

So while the current generation of caregivers is lost to the attrition of transition, maybe Millennials will help American medicine put this dark chapter firmly in the past.

But this supposed Digital Divide is not the biggest obstacle Millennial caregivers will face in their careers, nor the biggest determinant of burnout within the medical profession.

Physician burnout has been a problem in American healthcare for longer than the current generation of doctors has been practicing. The trend goes beyond the life of Meaningful Use, or the intrusion of new EHRs and associated workflows into the consultation space.

Compassion fatigue among frontline caregivers–nurses, social workers, emergency medicine staff, trauma physicians–is just beginning to creep into the mainstream, and has a long way to go yet to receive institutional coverage in med school, hospitals, and clinical environments where it is most prevalent.

Already, it is clear that Millennials are suffering from mental health disorders and complaints at a higher rate than any generation in history. Some of this dogged cohort will enter med school, an environment already given to catalyzing mental health conditions of students. Even with digital nativity aiding them in the transition from school to clinical practice, it is clear that all the ingredients for continued burnout are in place.

Physicians and other healthcare professionals, as a group, seem to routinely face mental health challenges to the point that it has become an unspoken occupational hazard.

So the great challenge for the next generation may not be making interoperability work, or striking a balance between regulation and pragmatism when it comes to utilization; rather, they will be struggling to tear down the mental-physical wall.

Of course, the challenge is not utterly unique to the younger generation–it is a legacy more entrenched than pen and paper records, more ubiquitous than white coats and stethoscopes. It is social, cultural, and professional, and it is still being buried by the ongoing preoccupation with digitization.

This may actually be to the advantage of the medical community and society at large. After all, EHR interoperability–and the various workflow failures and usability complaints–all amount to issues impeding communication. Fully realized, EHRs are really about facilitating communication, and interoperability about connecting the entire continuum of care.

The more EHRs emphasize behavioral health matters, the more chance providers and patients have to address this long-neglected component of health. Millennials are not the key to pursuing this target, but they could be in ensuring that behavioral health considerations are a prominent component of the care continuum. With some nudging, EHRs can actually help prevent burnout, rather than being scapegoated as its cause.

When we examine what keeps professionals in the field, and what burns them out, we should really take a second look at patient engagement. Again, EHRs and digitization make for easy culprits: cumbersome workflows, and a compulsion to treat EHRs as a third person in consultation–distracting doctors from their patients, and reducing the already too-short amount of face time they get to interact live and in person.

There is a fad of advocacy asserting that digital portals, IoT wearables, and mobile health systems will be a boon to patient engagement–and public health by extension. Adherence, early warnings enabling earlier interventions, easier check-ups, and reduced expenses are all supposedly contingent on the broad adoption and utilization of new and redeployed health technology.

But what may make for a much more deeply engaged patient is not inherently technological, but social. Bringing mental health complaints into greater focus, and encouraging more open discussion, self-assessment, and yes, even technology-aided monitoring, changes the game in a way it has long needed changing.

Primary care physicians are a prerequisite to accessing most other health services: insurance demands it, specialists expect it, prescriptions and pharmacies look for it. If the PCP is to be the one sure thing on which all the designs of public health and digital health management infrastructure depend on, then they must also be the most visible figures in behavioral health integration.

Keeping patients and caregivers alike engaged and safe requires this.

EHRs, Meaningful Use, and all the controversy over development, regulation, and government involvement in digitization makes for meaty debates and righteous fury, but it does not fundamentally alter the culture and practice of medicine in the same way that behavioral health integration would.

No one enters medicine without first experiencing life as a patient in some capacity. Protecting future generations of caregivers requires that they see behavioral health as relevant, important, and appropriate for discussion with their PCPs.

The doctor-patient relationship may be doomed to transformation in the digital age, but that doesn’t have to spell the end of old fashioned quality medicine. Old fashioned medicine, after all, was governed by old fashioned stigmas. As Millennials become the dominant cohort practicing medicine, more focus belongs on not just changing how doctors communicate with patients, but what they will be communicating about.

A generation of doctors who experienced the social stigma and private struggle with mental health issues may be the first step in declaring, together, “Never again,” on behalf of themselves, their peers, and their patients.

Edgar Wilson is an Oregon-based independent consultant who writes on trends in education, healthcare, and public policy.

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