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Rx for resilience: Five prescriptions for physician burnout
Physician burnout persists even as the height of the COVID-19 crisis fades farther into the rear-view mirror. The causes for the sadness, stress, and frustration among doctors vary, but the effects are universal and often debilitating: exhaustion, emotional detachment, lethargy, feeling useless, and lacking purpose.
When surveyed, physicians pointed to many systemic solutions for burnout in Medscape’s Physician Burnout & Depression Report 2023, such as a need for greater compensation, more manageable workloads and schedules, and more support staff. But for many doctors, these fixes may be years if not decades away. Equally important are strategies for relieving burnout symptoms now, especially as we head into a busy holiday season.
Because not every stress-relief practice works for everyone, it’s crucial to try various methods until you find something that makes a difference for you, said Christine Gibson, MD, a family physician and trauma therapist in Calgary, Alta., and author of The Modern Trauma Toolkit.
“Every person should have a toolkit of the things that bring them out of the psychological and physical distress that dysregulates their nervous system,” said Dr. Gibson.
Once you learn the personal ways to alleviate your specific brand of burnout, you can start working on systemic changes that might help the culture of medicine overall.
Symptoms speak louder than words
It seems obvious, but if you aren’t aware that what you’re feeling is burnout, you probably aren’t going to find effective steps to relieve it. Jessi Gold, MD, assistant professor and director of wellness, engagement, and outreach in the department of psychiatry, Washington University in St. Louis, is a psychiatrist who treats health care professionals, including frontline workers during the height of the pandemic. But even as a burnout expert, she admits that she misses the signs in herself.
“I was fighting constant fatigue, falling asleep the minute I got home from work every day, but I thought a B12 shot would solve all my problems. I didn’t realize I was having symptoms of burnout until my own therapist told me,” said Dr. Gold. “As doctors, we spend so much time focusing on other people that we don’t necessarily notice very much in ourselves – usually once it starts to impact our job.”
Practices like meditation and mindfulness can help you delve into your feelings and emotions and notice how you’re doing. But you may also need to ask spouses, partners, and friends and family – or better yet, a mental health professional – if they notice that you seem burnt out.
Practice ‘in the moment’ relief
Sometimes, walking away at the moment of stress helps like when stepping away from a heated argument. “Step out of a frustrating staff meeting to go to the bathroom and splash your face,” said Eran Magan, PhD, a psychologist at the University of Pennsylvania, Philadelphia, and founder and CEO of the suicide prevention system EarlyAlert.me. “Tell a patient you need to check something in the next room, so you have time to take a breath.”
Dr. Magan recommended finding techniques that help lower acute stress while it’s actually happening. First, find a way to escape or excuse yourself from the event, and when possible, stop situations that are actively upsetting or triggering in their tracks.
Next, recharge by doing something that helps you feel better, like looking at a cute video of your child or grandchild or closing your eyes and taking a deep breath. You can also try to “catch” good feelings from someone else, said Dr. Magan. Ask someone about a trip, vacation, holiday, or pleasant event. “Ask a colleague about something that makes [them] happy,” he said. “Happiness can be infectious too.”
Burnout is also in the body
“Body psychotherapy” or somatic therapy is a treatment that focuses on how emotions appear within your body. Dr. Gibson said it’s a valuable tool for addressing trauma and a mainstay in many a medical career; it’s useful to help physicians learn to “befriend” their nervous system.
Somatic therapy exercises involve things like body scanning, scanning for physical sensations; conscious breathing, connecting to each inhale and exhale; grounding your weight by releasing tension through your feet, doing a total body stretch; or releasing shoulder and neck tension by consciously relaxing each of these muscle groups.
“We spend our whole day in sympathetic tone; our amygdala’s are firing, telling us that we’re in danger,” said Dr. Gibson. “We actually have to practice getting into and spending time in our parasympathetic nervous system to restore the balance in our autonomic nervous system.”
Somatic therapy includes a wide array of exercises that help reconnect you to your body through calming or activation. The movements release tension, ground you, and restore balance.
Bite-sized tools for well-being
Because of the prevalence of physician burnout, there’s been a groundswell of researchers and organizations who have turned their focus toward improving the well-being in the health care workforce.
One such effort comes from the Duke Center for the Advancement of Well-being Science, which “camouflages” well-being tools as continuing education credits to make them accessible for busy, stressed, and overworked physicians.
“They’re called bite-sized tools for well-being, and they have actual evidence behind them,” said Dr. Gold. For example, she said, one tools is a text program called Three Good Things that encourages physicians to send a text listing three positive things that happened during the day. The exercise lasts 15 days, and texters have access to others’ answers as well. After 3 months, participants’ baseline depression, gratitude, and life satisfaction had all “significantly improved.”
“It feels almost ridiculous that that could work, but it does,” said Dr. Gold. “I’ve had patients push back and say: ‘Well, isn’t that toxic positivity?’ But really what it is is dialectics. It’s not saying there’s only positive; it’s just making you realize there is more than just the negative.”
These and other short interventions focus on concepts such as joy, humor, awe, engagement, and self-kindness to build resilience and help physicians recover from burnout symptoms.
Cognitive restructuring could work
Cognitive restructuring is a therapeutic process of learning new ways of interpreting and responding to people and situations. It helps you change the “filter” through which you interact with your environment. Dr. Gibson said it’s a tool to use with care after other modes of therapy that help you understand your patterns and how they developed because of how you view and understand the world.
“The message of [cognitive-behavioral therapy] or cognitive restructuring is there’s something wrong with the way you’re thinking, and we need to change it or fix it, but in a traumatic system [like health care], you’re thinking has been an adaptive process related to the harm in the environment you’re in,” said Dr. Gibson.
“So, if you [jump straight to cognitive restructuring before other types of therapy], then we just gaslight ourselves into believing that there’s something wrong with us, that we haven’t adapted sufficiently to an environment that’s actually harmful.”
Strive for a few systemic changes
Systemic changes can be small ones within your own sphere. For example, Dr. Magan said, work toward making little tweaks to the flow of your day that will increase calm and reduce frustration.
“Make a ‘bug list,’ little, regular demands that drain your energy, and discuss them with your colleagues and supervisors to see if they can be improved,” he said. Examples include everyday frustrations like having unsolicited visitors popping into your office, scheduling complex patients too late in the day, or having a computer freeze whenever you access patient charts.
Though not always financially feasible, affecting real change and finding relief from all these insidious bugs can improve your mental health and burnout symptoms.
“Physicians tend to work extremely hard in order to keep holding together a system that is often not inherently sustainable, like the fascia of a body under tremendous strain,” said Dr. Magan. “Sometimes the brave thing to do is to refuse to continue being the lynchpin and let things break, so the system will have to start improving itself, rather than demanding more and more of the people in it.”
A version of this article first appeared on Medscape.com.
Physician burnout persists even as the height of the COVID-19 crisis fades farther into the rear-view mirror. The causes for the sadness, stress, and frustration among doctors vary, but the effects are universal and often debilitating: exhaustion, emotional detachment, lethargy, feeling useless, and lacking purpose.
When surveyed, physicians pointed to many systemic solutions for burnout in Medscape’s Physician Burnout & Depression Report 2023, such as a need for greater compensation, more manageable workloads and schedules, and more support staff. But for many doctors, these fixes may be years if not decades away. Equally important are strategies for relieving burnout symptoms now, especially as we head into a busy holiday season.
Because not every stress-relief practice works for everyone, it’s crucial to try various methods until you find something that makes a difference for you, said Christine Gibson, MD, a family physician and trauma therapist in Calgary, Alta., and author of The Modern Trauma Toolkit.
“Every person should have a toolkit of the things that bring them out of the psychological and physical distress that dysregulates their nervous system,” said Dr. Gibson.
Once you learn the personal ways to alleviate your specific brand of burnout, you can start working on systemic changes that might help the culture of medicine overall.
Symptoms speak louder than words
It seems obvious, but if you aren’t aware that what you’re feeling is burnout, you probably aren’t going to find effective steps to relieve it. Jessi Gold, MD, assistant professor and director of wellness, engagement, and outreach in the department of psychiatry, Washington University in St. Louis, is a psychiatrist who treats health care professionals, including frontline workers during the height of the pandemic. But even as a burnout expert, she admits that she misses the signs in herself.
“I was fighting constant fatigue, falling asleep the minute I got home from work every day, but I thought a B12 shot would solve all my problems. I didn’t realize I was having symptoms of burnout until my own therapist told me,” said Dr. Gold. “As doctors, we spend so much time focusing on other people that we don’t necessarily notice very much in ourselves – usually once it starts to impact our job.”
Practices like meditation and mindfulness can help you delve into your feelings and emotions and notice how you’re doing. But you may also need to ask spouses, partners, and friends and family – or better yet, a mental health professional – if they notice that you seem burnt out.
Practice ‘in the moment’ relief
Sometimes, walking away at the moment of stress helps like when stepping away from a heated argument. “Step out of a frustrating staff meeting to go to the bathroom and splash your face,” said Eran Magan, PhD, a psychologist at the University of Pennsylvania, Philadelphia, and founder and CEO of the suicide prevention system EarlyAlert.me. “Tell a patient you need to check something in the next room, so you have time to take a breath.”
Dr. Magan recommended finding techniques that help lower acute stress while it’s actually happening. First, find a way to escape or excuse yourself from the event, and when possible, stop situations that are actively upsetting or triggering in their tracks.
Next, recharge by doing something that helps you feel better, like looking at a cute video of your child or grandchild or closing your eyes and taking a deep breath. You can also try to “catch” good feelings from someone else, said Dr. Magan. Ask someone about a trip, vacation, holiday, or pleasant event. “Ask a colleague about something that makes [them] happy,” he said. “Happiness can be infectious too.”
Burnout is also in the body
“Body psychotherapy” or somatic therapy is a treatment that focuses on how emotions appear within your body. Dr. Gibson said it’s a valuable tool for addressing trauma and a mainstay in many a medical career; it’s useful to help physicians learn to “befriend” their nervous system.
Somatic therapy exercises involve things like body scanning, scanning for physical sensations; conscious breathing, connecting to each inhale and exhale; grounding your weight by releasing tension through your feet, doing a total body stretch; or releasing shoulder and neck tension by consciously relaxing each of these muscle groups.
“We spend our whole day in sympathetic tone; our amygdala’s are firing, telling us that we’re in danger,” said Dr. Gibson. “We actually have to practice getting into and spending time in our parasympathetic nervous system to restore the balance in our autonomic nervous system.”
Somatic therapy includes a wide array of exercises that help reconnect you to your body through calming or activation. The movements release tension, ground you, and restore balance.
Bite-sized tools for well-being
Because of the prevalence of physician burnout, there’s been a groundswell of researchers and organizations who have turned their focus toward improving the well-being in the health care workforce.
One such effort comes from the Duke Center for the Advancement of Well-being Science, which “camouflages” well-being tools as continuing education credits to make them accessible for busy, stressed, and overworked physicians.
“They’re called bite-sized tools for well-being, and they have actual evidence behind them,” said Dr. Gold. For example, she said, one tools is a text program called Three Good Things that encourages physicians to send a text listing three positive things that happened during the day. The exercise lasts 15 days, and texters have access to others’ answers as well. After 3 months, participants’ baseline depression, gratitude, and life satisfaction had all “significantly improved.”
“It feels almost ridiculous that that could work, but it does,” said Dr. Gold. “I’ve had patients push back and say: ‘Well, isn’t that toxic positivity?’ But really what it is is dialectics. It’s not saying there’s only positive; it’s just making you realize there is more than just the negative.”
These and other short interventions focus on concepts such as joy, humor, awe, engagement, and self-kindness to build resilience and help physicians recover from burnout symptoms.
Cognitive restructuring could work
Cognitive restructuring is a therapeutic process of learning new ways of interpreting and responding to people and situations. It helps you change the “filter” through which you interact with your environment. Dr. Gibson said it’s a tool to use with care after other modes of therapy that help you understand your patterns and how they developed because of how you view and understand the world.
“The message of [cognitive-behavioral therapy] or cognitive restructuring is there’s something wrong with the way you’re thinking, and we need to change it or fix it, but in a traumatic system [like health care], you’re thinking has been an adaptive process related to the harm in the environment you’re in,” said Dr. Gibson.
“So, if you [jump straight to cognitive restructuring before other types of therapy], then we just gaslight ourselves into believing that there’s something wrong with us, that we haven’t adapted sufficiently to an environment that’s actually harmful.”
Strive for a few systemic changes
Systemic changes can be small ones within your own sphere. For example, Dr. Magan said, work toward making little tweaks to the flow of your day that will increase calm and reduce frustration.
“Make a ‘bug list,’ little, regular demands that drain your energy, and discuss them with your colleagues and supervisors to see if they can be improved,” he said. Examples include everyday frustrations like having unsolicited visitors popping into your office, scheduling complex patients too late in the day, or having a computer freeze whenever you access patient charts.
Though not always financially feasible, affecting real change and finding relief from all these insidious bugs can improve your mental health and burnout symptoms.
“Physicians tend to work extremely hard in order to keep holding together a system that is often not inherently sustainable, like the fascia of a body under tremendous strain,” said Dr. Magan. “Sometimes the brave thing to do is to refuse to continue being the lynchpin and let things break, so the system will have to start improving itself, rather than demanding more and more of the people in it.”
A version of this article first appeared on Medscape.com.
Physician burnout persists even as the height of the COVID-19 crisis fades farther into the rear-view mirror. The causes for the sadness, stress, and frustration among doctors vary, but the effects are universal and often debilitating: exhaustion, emotional detachment, lethargy, feeling useless, and lacking purpose.
When surveyed, physicians pointed to many systemic solutions for burnout in Medscape’s Physician Burnout & Depression Report 2023, such as a need for greater compensation, more manageable workloads and schedules, and more support staff. But for many doctors, these fixes may be years if not decades away. Equally important are strategies for relieving burnout symptoms now, especially as we head into a busy holiday season.
Because not every stress-relief practice works for everyone, it’s crucial to try various methods until you find something that makes a difference for you, said Christine Gibson, MD, a family physician and trauma therapist in Calgary, Alta., and author of The Modern Trauma Toolkit.
“Every person should have a toolkit of the things that bring them out of the psychological and physical distress that dysregulates their nervous system,” said Dr. Gibson.
Once you learn the personal ways to alleviate your specific brand of burnout, you can start working on systemic changes that might help the culture of medicine overall.
Symptoms speak louder than words
It seems obvious, but if you aren’t aware that what you’re feeling is burnout, you probably aren’t going to find effective steps to relieve it. Jessi Gold, MD, assistant professor and director of wellness, engagement, and outreach in the department of psychiatry, Washington University in St. Louis, is a psychiatrist who treats health care professionals, including frontline workers during the height of the pandemic. But even as a burnout expert, she admits that she misses the signs in herself.
“I was fighting constant fatigue, falling asleep the minute I got home from work every day, but I thought a B12 shot would solve all my problems. I didn’t realize I was having symptoms of burnout until my own therapist told me,” said Dr. Gold. “As doctors, we spend so much time focusing on other people that we don’t necessarily notice very much in ourselves – usually once it starts to impact our job.”
Practices like meditation and mindfulness can help you delve into your feelings and emotions and notice how you’re doing. But you may also need to ask spouses, partners, and friends and family – or better yet, a mental health professional – if they notice that you seem burnt out.
Practice ‘in the moment’ relief
Sometimes, walking away at the moment of stress helps like when stepping away from a heated argument. “Step out of a frustrating staff meeting to go to the bathroom and splash your face,” said Eran Magan, PhD, a psychologist at the University of Pennsylvania, Philadelphia, and founder and CEO of the suicide prevention system EarlyAlert.me. “Tell a patient you need to check something in the next room, so you have time to take a breath.”
Dr. Magan recommended finding techniques that help lower acute stress while it’s actually happening. First, find a way to escape or excuse yourself from the event, and when possible, stop situations that are actively upsetting or triggering in their tracks.
Next, recharge by doing something that helps you feel better, like looking at a cute video of your child or grandchild or closing your eyes and taking a deep breath. You can also try to “catch” good feelings from someone else, said Dr. Magan. Ask someone about a trip, vacation, holiday, or pleasant event. “Ask a colleague about something that makes [them] happy,” he said. “Happiness can be infectious too.”
Burnout is also in the body
“Body psychotherapy” or somatic therapy is a treatment that focuses on how emotions appear within your body. Dr. Gibson said it’s a valuable tool for addressing trauma and a mainstay in many a medical career; it’s useful to help physicians learn to “befriend” their nervous system.
Somatic therapy exercises involve things like body scanning, scanning for physical sensations; conscious breathing, connecting to each inhale and exhale; grounding your weight by releasing tension through your feet, doing a total body stretch; or releasing shoulder and neck tension by consciously relaxing each of these muscle groups.
“We spend our whole day in sympathetic tone; our amygdala’s are firing, telling us that we’re in danger,” said Dr. Gibson. “We actually have to practice getting into and spending time in our parasympathetic nervous system to restore the balance in our autonomic nervous system.”
Somatic therapy includes a wide array of exercises that help reconnect you to your body through calming or activation. The movements release tension, ground you, and restore balance.
Bite-sized tools for well-being
Because of the prevalence of physician burnout, there’s been a groundswell of researchers and organizations who have turned their focus toward improving the well-being in the health care workforce.
One such effort comes from the Duke Center for the Advancement of Well-being Science, which “camouflages” well-being tools as continuing education credits to make them accessible for busy, stressed, and overworked physicians.
“They’re called bite-sized tools for well-being, and they have actual evidence behind them,” said Dr. Gold. For example, she said, one tools is a text program called Three Good Things that encourages physicians to send a text listing three positive things that happened during the day. The exercise lasts 15 days, and texters have access to others’ answers as well. After 3 months, participants’ baseline depression, gratitude, and life satisfaction had all “significantly improved.”
“It feels almost ridiculous that that could work, but it does,” said Dr. Gold. “I’ve had patients push back and say: ‘Well, isn’t that toxic positivity?’ But really what it is is dialectics. It’s not saying there’s only positive; it’s just making you realize there is more than just the negative.”
These and other short interventions focus on concepts such as joy, humor, awe, engagement, and self-kindness to build resilience and help physicians recover from burnout symptoms.
Cognitive restructuring could work
Cognitive restructuring is a therapeutic process of learning new ways of interpreting and responding to people and situations. It helps you change the “filter” through which you interact with your environment. Dr. Gibson said it’s a tool to use with care after other modes of therapy that help you understand your patterns and how they developed because of how you view and understand the world.
“The message of [cognitive-behavioral therapy] or cognitive restructuring is there’s something wrong with the way you’re thinking, and we need to change it or fix it, but in a traumatic system [like health care], you’re thinking has been an adaptive process related to the harm in the environment you’re in,” said Dr. Gibson.
“So, if you [jump straight to cognitive restructuring before other types of therapy], then we just gaslight ourselves into believing that there’s something wrong with us, that we haven’t adapted sufficiently to an environment that’s actually harmful.”
Strive for a few systemic changes
Systemic changes can be small ones within your own sphere. For example, Dr. Magan said, work toward making little tweaks to the flow of your day that will increase calm and reduce frustration.
“Make a ‘bug list,’ little, regular demands that drain your energy, and discuss them with your colleagues and supervisors to see if they can be improved,” he said. Examples include everyday frustrations like having unsolicited visitors popping into your office, scheduling complex patients too late in the day, or having a computer freeze whenever you access patient charts.
Though not always financially feasible, affecting real change and finding relief from all these insidious bugs can improve your mental health and burnout symptoms.
“Physicians tend to work extremely hard in order to keep holding together a system that is often not inherently sustainable, like the fascia of a body under tremendous strain,” said Dr. Magan. “Sometimes the brave thing to do is to refuse to continue being the lynchpin and let things break, so the system will have to start improving itself, rather than demanding more and more of the people in it.”
A version of this article first appeared on Medscape.com.
Another day in the ED: Walking the line between empathy and desensitization
Patient after patient, emergency medicine physicians experience highs and lows, sometimes minutes apart. “It might be another Tuesday for us, but for the patient in that dramatic life moment on that day, it’s everything,” said Charissa Pacella, MD, chief of emergency medicine at UPMC Presbyterian in Pittsburgh.
Emergency department (ED) physicians frequently encounter fatal situations, feel frustration when they can’t save a person, and constantly see patients in distress. How do physicians weather the emotional storm of life in the ED with both their mental health and empathy intact?
Reserve time for emotions
Dr. Pacella, who has been practicing emergency medicine for 22 years, also serves in a leadership role for Physicians for Physicians, a confidential peer support program at UPMC for doctors struggling with the impact of adverse events and the stress they face. She said it’s essential to know how to compartmentalize and focus on the task at hand, but later revisit emotions from a personal perspective.
“We all separate our cognitive and leadership roles from our emotional response in the moment,” she said. “Everybody is just focused on doing the next right thing. And often it’s not until sometime later when you sit down or go home or maybe even going in for your next shift that it really hits you in a more emotional way.”
If you try to avoid or skip over this part of the process by shoving the emotions down and ignoring them, Dr. Pacella said, you leave out a crucial part of the care process. And over the course of a career, you’ll risk losing empathy and the human connection that most doctors went into medicine for, she told this news organization.
Connect with your colleagues
Physicians supporting each other is crucial, said Dr Pacella. And luckily, she added, connection tends to be a strength of the specialty.
“As emergency medicine physicians, we share a lot in common, and part of it is what brought us to choose this specialty in the first place. You picked it because there’s something appealing to you about the unknown. It’s a unique role, a unique environment, and a unique relationship you have with patients and being able to connect with colleagues,” she said.
Lisa Williford, MD, emergency medicine specialist at Texas Health Harris Methodist Hospital in Fort Worth, said her 14-year career has taught her that no matter how focused a medical professional can stay in the moment, emotions are happening at some level.
“During a level 1 trauma, there are a lot of people in the room – trauma surgeons, residents, nurses, x-ray techs, respiratory therapy, anesthesia – and every one of us is having emotions. It’s not realistic to think anyone is avoiding it.”
But beyond simply recognizing a shared experience, it’s important to talk to each other. It’s not just about how you’re feeling, but also what you do to help manage that emotional load.
“I’d say that more of us, especially since COVID, are learning that actually getting a therapist is a good thing, having a life coach is a good thing,” said Dr. Williford. Accepting mental health care and learning how to manage it is also a good thing.
Accept unpredictability
You may think you know how a difficult situation will affect you, but that assumption can put you in a vulnerable position. Dr. Pacella said she’s learned that for most physicians, a stress response to a critical incident often has less to do with the type of event and more about who is involved or your past experiences.
“I have reacted in a very emotional way at moments that I would never have expected or predicted,” said Dr. Pacella. “And it’s not always because of some awful event. It’s usually because of some emotional connection or trigger embedded in that encounter.”
For example, she said, you may have had a past case as an emergency physician where the outcome was not favorable, or the patient involved may remind you of yourself or someone you love.
“It might not necessarily be a horrible thing happening to a young, healthy person that triggers someone; it might be a minor problem involving a patient you, for whatever reason, identify with,” she said. “Or you may have had a similar patient where things didn’t go well for them. It’s just highly variable, even for an individual.”
Just as you can’t know what medical issues you’ll face in a day, you can’t predict how you’ll react. Approach each scenario with the knowledge that you may veer off emotional course – and prepare accordingly.
Bring mental wellness to the forefront of training
Dr. Williford, who also serves as regional director for ScribeNest, a doctor-operated company that trains medical scribes who are on the path to becoming medical professionals, said she feels strongly about bringing this conversation to the younger generation.
“For me, nobody at the med school level or residency level taught or talked about how to compartmentalize and cope with the traumatic experiences that we saw,” she said. “Only in the last decade have we started teaching our residents and medical students about burnout and resilience.
“I say things like, ‘Hey, we just witnessed an 18-year-old in cardiac arrest. We did CPR for an hour and didn’t get him back. And then you witnessed me tell his mom, who wailed. And then we turned around and treated an ankle sprain. Let’s sit down and talk about how jarring that all is and how nobody else experiences these things.’
“We have this expectation that our physicians know how to move on and connect with each new patient with care and empathy, but we have to tell our future doctors the actual steps we take to be able to do that.”
Seasoned physicians can lead the way for the next generation and turn the tide toward the normalization of talking about these struggles. By making it part of training, it becomes part of a physician’s skill set.
“With a happy, healthy career, we can pay it forward to the next generation and teach them how to be better than we were,” said Dr. Williford.
A version of this article appeared on Medscape.com.
Patient after patient, emergency medicine physicians experience highs and lows, sometimes minutes apart. “It might be another Tuesday for us, but for the patient in that dramatic life moment on that day, it’s everything,” said Charissa Pacella, MD, chief of emergency medicine at UPMC Presbyterian in Pittsburgh.
Emergency department (ED) physicians frequently encounter fatal situations, feel frustration when they can’t save a person, and constantly see patients in distress. How do physicians weather the emotional storm of life in the ED with both their mental health and empathy intact?
Reserve time for emotions
Dr. Pacella, who has been practicing emergency medicine for 22 years, also serves in a leadership role for Physicians for Physicians, a confidential peer support program at UPMC for doctors struggling with the impact of adverse events and the stress they face. She said it’s essential to know how to compartmentalize and focus on the task at hand, but later revisit emotions from a personal perspective.
“We all separate our cognitive and leadership roles from our emotional response in the moment,” she said. “Everybody is just focused on doing the next right thing. And often it’s not until sometime later when you sit down or go home or maybe even going in for your next shift that it really hits you in a more emotional way.”
If you try to avoid or skip over this part of the process by shoving the emotions down and ignoring them, Dr. Pacella said, you leave out a crucial part of the care process. And over the course of a career, you’ll risk losing empathy and the human connection that most doctors went into medicine for, she told this news organization.
Connect with your colleagues
Physicians supporting each other is crucial, said Dr Pacella. And luckily, she added, connection tends to be a strength of the specialty.
“As emergency medicine physicians, we share a lot in common, and part of it is what brought us to choose this specialty in the first place. You picked it because there’s something appealing to you about the unknown. It’s a unique role, a unique environment, and a unique relationship you have with patients and being able to connect with colleagues,” she said.
Lisa Williford, MD, emergency medicine specialist at Texas Health Harris Methodist Hospital in Fort Worth, said her 14-year career has taught her that no matter how focused a medical professional can stay in the moment, emotions are happening at some level.
“During a level 1 trauma, there are a lot of people in the room – trauma surgeons, residents, nurses, x-ray techs, respiratory therapy, anesthesia – and every one of us is having emotions. It’s not realistic to think anyone is avoiding it.”
But beyond simply recognizing a shared experience, it’s important to talk to each other. It’s not just about how you’re feeling, but also what you do to help manage that emotional load.
“I’d say that more of us, especially since COVID, are learning that actually getting a therapist is a good thing, having a life coach is a good thing,” said Dr. Williford. Accepting mental health care and learning how to manage it is also a good thing.
Accept unpredictability
You may think you know how a difficult situation will affect you, but that assumption can put you in a vulnerable position. Dr. Pacella said she’s learned that for most physicians, a stress response to a critical incident often has less to do with the type of event and more about who is involved or your past experiences.
“I have reacted in a very emotional way at moments that I would never have expected or predicted,” said Dr. Pacella. “And it’s not always because of some awful event. It’s usually because of some emotional connection or trigger embedded in that encounter.”
For example, she said, you may have had a past case as an emergency physician where the outcome was not favorable, or the patient involved may remind you of yourself or someone you love.
“It might not necessarily be a horrible thing happening to a young, healthy person that triggers someone; it might be a minor problem involving a patient you, for whatever reason, identify with,” she said. “Or you may have had a similar patient where things didn’t go well for them. It’s just highly variable, even for an individual.”
Just as you can’t know what medical issues you’ll face in a day, you can’t predict how you’ll react. Approach each scenario with the knowledge that you may veer off emotional course – and prepare accordingly.
Bring mental wellness to the forefront of training
Dr. Williford, who also serves as regional director for ScribeNest, a doctor-operated company that trains medical scribes who are on the path to becoming medical professionals, said she feels strongly about bringing this conversation to the younger generation.
“For me, nobody at the med school level or residency level taught or talked about how to compartmentalize and cope with the traumatic experiences that we saw,” she said. “Only in the last decade have we started teaching our residents and medical students about burnout and resilience.
“I say things like, ‘Hey, we just witnessed an 18-year-old in cardiac arrest. We did CPR for an hour and didn’t get him back. And then you witnessed me tell his mom, who wailed. And then we turned around and treated an ankle sprain. Let’s sit down and talk about how jarring that all is and how nobody else experiences these things.’
“We have this expectation that our physicians know how to move on and connect with each new patient with care and empathy, but we have to tell our future doctors the actual steps we take to be able to do that.”
Seasoned physicians can lead the way for the next generation and turn the tide toward the normalization of talking about these struggles. By making it part of training, it becomes part of a physician’s skill set.
“With a happy, healthy career, we can pay it forward to the next generation and teach them how to be better than we were,” said Dr. Williford.
A version of this article appeared on Medscape.com.
Patient after patient, emergency medicine physicians experience highs and lows, sometimes minutes apart. “It might be another Tuesday for us, but for the patient in that dramatic life moment on that day, it’s everything,” said Charissa Pacella, MD, chief of emergency medicine at UPMC Presbyterian in Pittsburgh.
Emergency department (ED) physicians frequently encounter fatal situations, feel frustration when they can’t save a person, and constantly see patients in distress. How do physicians weather the emotional storm of life in the ED with both their mental health and empathy intact?
Reserve time for emotions
Dr. Pacella, who has been practicing emergency medicine for 22 years, also serves in a leadership role for Physicians for Physicians, a confidential peer support program at UPMC for doctors struggling with the impact of adverse events and the stress they face. She said it’s essential to know how to compartmentalize and focus on the task at hand, but later revisit emotions from a personal perspective.
“We all separate our cognitive and leadership roles from our emotional response in the moment,” she said. “Everybody is just focused on doing the next right thing. And often it’s not until sometime later when you sit down or go home or maybe even going in for your next shift that it really hits you in a more emotional way.”
If you try to avoid or skip over this part of the process by shoving the emotions down and ignoring them, Dr. Pacella said, you leave out a crucial part of the care process. And over the course of a career, you’ll risk losing empathy and the human connection that most doctors went into medicine for, she told this news organization.
Connect with your colleagues
Physicians supporting each other is crucial, said Dr Pacella. And luckily, she added, connection tends to be a strength of the specialty.
“As emergency medicine physicians, we share a lot in common, and part of it is what brought us to choose this specialty in the first place. You picked it because there’s something appealing to you about the unknown. It’s a unique role, a unique environment, and a unique relationship you have with patients and being able to connect with colleagues,” she said.
Lisa Williford, MD, emergency medicine specialist at Texas Health Harris Methodist Hospital in Fort Worth, said her 14-year career has taught her that no matter how focused a medical professional can stay in the moment, emotions are happening at some level.
“During a level 1 trauma, there are a lot of people in the room – trauma surgeons, residents, nurses, x-ray techs, respiratory therapy, anesthesia – and every one of us is having emotions. It’s not realistic to think anyone is avoiding it.”
But beyond simply recognizing a shared experience, it’s important to talk to each other. It’s not just about how you’re feeling, but also what you do to help manage that emotional load.
“I’d say that more of us, especially since COVID, are learning that actually getting a therapist is a good thing, having a life coach is a good thing,” said Dr. Williford. Accepting mental health care and learning how to manage it is also a good thing.
Accept unpredictability
You may think you know how a difficult situation will affect you, but that assumption can put you in a vulnerable position. Dr. Pacella said she’s learned that for most physicians, a stress response to a critical incident often has less to do with the type of event and more about who is involved or your past experiences.
“I have reacted in a very emotional way at moments that I would never have expected or predicted,” said Dr. Pacella. “And it’s not always because of some awful event. It’s usually because of some emotional connection or trigger embedded in that encounter.”
For example, she said, you may have had a past case as an emergency physician where the outcome was not favorable, or the patient involved may remind you of yourself or someone you love.
“It might not necessarily be a horrible thing happening to a young, healthy person that triggers someone; it might be a minor problem involving a patient you, for whatever reason, identify with,” she said. “Or you may have had a similar patient where things didn’t go well for them. It’s just highly variable, even for an individual.”
Just as you can’t know what medical issues you’ll face in a day, you can’t predict how you’ll react. Approach each scenario with the knowledge that you may veer off emotional course – and prepare accordingly.
Bring mental wellness to the forefront of training
Dr. Williford, who also serves as regional director for ScribeNest, a doctor-operated company that trains medical scribes who are on the path to becoming medical professionals, said she feels strongly about bringing this conversation to the younger generation.
“For me, nobody at the med school level or residency level taught or talked about how to compartmentalize and cope with the traumatic experiences that we saw,” she said. “Only in the last decade have we started teaching our residents and medical students about burnout and resilience.
“I say things like, ‘Hey, we just witnessed an 18-year-old in cardiac arrest. We did CPR for an hour and didn’t get him back. And then you witnessed me tell his mom, who wailed. And then we turned around and treated an ankle sprain. Let’s sit down and talk about how jarring that all is and how nobody else experiences these things.’
“We have this expectation that our physicians know how to move on and connect with each new patient with care and empathy, but we have to tell our future doctors the actual steps we take to be able to do that.”
Seasoned physicians can lead the way for the next generation and turn the tide toward the normalization of talking about these struggles. By making it part of training, it becomes part of a physician’s skill set.
“With a happy, healthy career, we can pay it forward to the next generation and teach them how to be better than we were,” said Dr. Williford.
A version of this article appeared on Medscape.com.
Five ways to avert a malpractice lawsuit with better EHR techniques
Although most physicians have gotten used to working with EHRs, despite their irritations, the use of EHRs has contributed to a growing number of malpractice lawsuits. Defense attorneys say that
According to a study in the Journal of Patient Safety, more than 30% of all EHR-related malpractice cases are associated with medication errors; 28% with diagnosis; and 31% with a complication of treatment, such as entering wrong information, entering information in the wrong place, and overlooking EHR flags and warnings for interactions or contraindications.
The study gave these examples of EHR-related errors that led to patient harm and ultimately to malpractice lawsuits:
- A discharge order omitted a patient’s medication that prevented strokes; the patient had a stroke days later.
- An electronic order for morphine failed to state the upper dose limit; the patient died.
- A physician meant to click on “discontinue” for an anticoagulant but mistakenly clicked on “continue” for home use.
Catching potential issues such as drug interactions or critical medical history that should inform treatment is more important than ever. “We know from safety engineering principles that just relying on vigilance is not a long-term safety strategy,” says Aaron Zach Hettinger, MD, chief research information officer at MedStar Health Research Institute, Washington, D.C. “So, it’s critical that we design these safe systems and leverage the data that’s in them.”
Here are five smart EHR practices to help protect your patients’ health and your own liability.
1. Double-check dropdown boxes
When it comes to user error, it’s easy to click the wrong choice from a drop-down menu. Better to take the time to explain your answer in a box, even if it takes a few more minutes. Or if you are choosing from a menu, proofread any information it auto-fills in the chart.
Dr. Hettinger says you can strike a balance between these templated approaches to diagnosis and long-term care by working with third-party systems and your organization or vendor IT department to help with follow-up questions to keep populated data in check.
“Make sure you have a back-end system that can help monitor that structured data,” says Dr. Hettinger. Structured data are the patient’s demographic information, like name, address, age, height, weight, vital signs, and data elements like diagnosis, medications, and lab results. “Wherever you can leverage the underlying tools that are part of the electronic health record to make sure that we’re constantly checking the right results, that helps reduce the workload so that clinicians can focus on taking care of the patients and doing the right thing and not be as focused on entering data into the system.”
2. Supplement EHR notes with direct communication
The failure to diagnose cancer because one physician doesn’t know what another physician saw in an imaging report is one of the most common claims in the cases he tries, says Aaron Boeder, a plaintiff’s medical negligence lawyer in Chicago.
Physicians often assume that if they put a note in the electronic chart, others will look for it, but Mr. Boeder says it’s far more prudent to communicate directly.
“Let’s say a radiologist interprets a scan and sees what might be cancer,” he says. “If the ordering doctor is an orthopedist who’s ordered a CT scan for DVT, there’s going to be a report for that scan. It’s going to get auto-populated back into that physician’s note,” says Mr. Boeder.
The physician may or may not look at it, but it will be in their note, and they’re supposed to follow up on it because they ordered the scan. “But they may not follow up on it, and they may not get a call from the radiologist,” he says.
“Next thing you know, 2 or 3 years later, that patient is diagnosed with very advanced cancer.”
3. Tailor auto-fill information to your common practices
Suppose, as a physician, you find that you need to change a default setting time and time again. Dr. Hettinger says it’s worth your time to take an extra couple of minutes to work with your vendor or your health system to try and make changes to auto-population settings that align with your practices.
“Let’s say a default dose of 20 milligrams of a medication is what automatically pops up, but in reality, your practice is to use a smaller dose because it’s safer, even though they’re all within the acceptable realm of what you would order,” he says. “Rather than have the default to the higher dose, see if you can change the default to a lower dose. And that way, you don’t have to catch yourself every time.”
If your auto-fills are amounts that constantly need changing, an interruption could easily knock you off course before you make that correction.
“If there are ways to have the system defaults be safer or more in line with your clinical practice, and especially across a group, then you’re designing a safer system and not relying on vigilance or memory prone to interruptions,” says Dr. Hettinger.
4. Curb the copy and paste
It’s tempting to copy a note from a previous patient visit and make only minimal changes as needed, but you risk including outdated information if you do. Even if you’re repeating questions asked by the intake nurse, it is safer to not to rely on that information, says Beth Kanik, a defense medical malpractice attorney in Atlanta.
“If it later goes into litigation, the argument then becomes that it looks like you didn’t do your job,” says Ms. Kanik. “Instead, try to ask questions in a way that would elicit responses that may be a little different than what the nurse got, so that it’s clear you asked the questions and didn’t just simply rely upon someone else’s information.”
5. Separate typing from listening
While EHR may be an excellent tool for data collection and safety checking, it’s not a stand-in for doctor-patient interaction. As technology practices push medicine toward more and more efficiency, Mr. Boeder says it’s most often listening over all else that makes the difference in the quality of care. And good listening requires full attention.
“A real concern for physicians is the number of visits they’re expected to accomplish in a set amount of time,” says Mr. Boeder. “Often this translates into a doctor talking to a patient while typing notes or while reading a note from the last time the patient was in.”
Taking the time to pause after entering data and briefly reviewing your understanding of what your patient has told you can be invaluable and may save you – and your patient – problems later.
“In so many cases, it comes down to people not being heard,” says Mr. Boeder. “So listen to what your patients are saying.”
A version of this article first appeared on Medscape.com.
Although most physicians have gotten used to working with EHRs, despite their irritations, the use of EHRs has contributed to a growing number of malpractice lawsuits. Defense attorneys say that
According to a study in the Journal of Patient Safety, more than 30% of all EHR-related malpractice cases are associated with medication errors; 28% with diagnosis; and 31% with a complication of treatment, such as entering wrong information, entering information in the wrong place, and overlooking EHR flags and warnings for interactions or contraindications.
The study gave these examples of EHR-related errors that led to patient harm and ultimately to malpractice lawsuits:
- A discharge order omitted a patient’s medication that prevented strokes; the patient had a stroke days later.
- An electronic order for morphine failed to state the upper dose limit; the patient died.
- A physician meant to click on “discontinue” for an anticoagulant but mistakenly clicked on “continue” for home use.
Catching potential issues such as drug interactions or critical medical history that should inform treatment is more important than ever. “We know from safety engineering principles that just relying on vigilance is not a long-term safety strategy,” says Aaron Zach Hettinger, MD, chief research information officer at MedStar Health Research Institute, Washington, D.C. “So, it’s critical that we design these safe systems and leverage the data that’s in them.”
Here are five smart EHR practices to help protect your patients’ health and your own liability.
1. Double-check dropdown boxes
When it comes to user error, it’s easy to click the wrong choice from a drop-down menu. Better to take the time to explain your answer in a box, even if it takes a few more minutes. Or if you are choosing from a menu, proofread any information it auto-fills in the chart.
Dr. Hettinger says you can strike a balance between these templated approaches to diagnosis and long-term care by working with third-party systems and your organization or vendor IT department to help with follow-up questions to keep populated data in check.
“Make sure you have a back-end system that can help monitor that structured data,” says Dr. Hettinger. Structured data are the patient’s demographic information, like name, address, age, height, weight, vital signs, and data elements like diagnosis, medications, and lab results. “Wherever you can leverage the underlying tools that are part of the electronic health record to make sure that we’re constantly checking the right results, that helps reduce the workload so that clinicians can focus on taking care of the patients and doing the right thing and not be as focused on entering data into the system.”
2. Supplement EHR notes with direct communication
The failure to diagnose cancer because one physician doesn’t know what another physician saw in an imaging report is one of the most common claims in the cases he tries, says Aaron Boeder, a plaintiff’s medical negligence lawyer in Chicago.
Physicians often assume that if they put a note in the electronic chart, others will look for it, but Mr. Boeder says it’s far more prudent to communicate directly.
“Let’s say a radiologist interprets a scan and sees what might be cancer,” he says. “If the ordering doctor is an orthopedist who’s ordered a CT scan for DVT, there’s going to be a report for that scan. It’s going to get auto-populated back into that physician’s note,” says Mr. Boeder.
The physician may or may not look at it, but it will be in their note, and they’re supposed to follow up on it because they ordered the scan. “But they may not follow up on it, and they may not get a call from the radiologist,” he says.
“Next thing you know, 2 or 3 years later, that patient is diagnosed with very advanced cancer.”
3. Tailor auto-fill information to your common practices
Suppose, as a physician, you find that you need to change a default setting time and time again. Dr. Hettinger says it’s worth your time to take an extra couple of minutes to work with your vendor or your health system to try and make changes to auto-population settings that align with your practices.
“Let’s say a default dose of 20 milligrams of a medication is what automatically pops up, but in reality, your practice is to use a smaller dose because it’s safer, even though they’re all within the acceptable realm of what you would order,” he says. “Rather than have the default to the higher dose, see if you can change the default to a lower dose. And that way, you don’t have to catch yourself every time.”
If your auto-fills are amounts that constantly need changing, an interruption could easily knock you off course before you make that correction.
“If there are ways to have the system defaults be safer or more in line with your clinical practice, and especially across a group, then you’re designing a safer system and not relying on vigilance or memory prone to interruptions,” says Dr. Hettinger.
4. Curb the copy and paste
It’s tempting to copy a note from a previous patient visit and make only minimal changes as needed, but you risk including outdated information if you do. Even if you’re repeating questions asked by the intake nurse, it is safer to not to rely on that information, says Beth Kanik, a defense medical malpractice attorney in Atlanta.
“If it later goes into litigation, the argument then becomes that it looks like you didn’t do your job,” says Ms. Kanik. “Instead, try to ask questions in a way that would elicit responses that may be a little different than what the nurse got, so that it’s clear you asked the questions and didn’t just simply rely upon someone else’s information.”
5. Separate typing from listening
While EHR may be an excellent tool for data collection and safety checking, it’s not a stand-in for doctor-patient interaction. As technology practices push medicine toward more and more efficiency, Mr. Boeder says it’s most often listening over all else that makes the difference in the quality of care. And good listening requires full attention.
“A real concern for physicians is the number of visits they’re expected to accomplish in a set amount of time,” says Mr. Boeder. “Often this translates into a doctor talking to a patient while typing notes or while reading a note from the last time the patient was in.”
Taking the time to pause after entering data and briefly reviewing your understanding of what your patient has told you can be invaluable and may save you – and your patient – problems later.
“In so many cases, it comes down to people not being heard,” says Mr. Boeder. “So listen to what your patients are saying.”
A version of this article first appeared on Medscape.com.
Although most physicians have gotten used to working with EHRs, despite their irritations, the use of EHRs has contributed to a growing number of malpractice lawsuits. Defense attorneys say that
According to a study in the Journal of Patient Safety, more than 30% of all EHR-related malpractice cases are associated with medication errors; 28% with diagnosis; and 31% with a complication of treatment, such as entering wrong information, entering information in the wrong place, and overlooking EHR flags and warnings for interactions or contraindications.
The study gave these examples of EHR-related errors that led to patient harm and ultimately to malpractice lawsuits:
- A discharge order omitted a patient’s medication that prevented strokes; the patient had a stroke days later.
- An electronic order for morphine failed to state the upper dose limit; the patient died.
- A physician meant to click on “discontinue” for an anticoagulant but mistakenly clicked on “continue” for home use.
Catching potential issues such as drug interactions or critical medical history that should inform treatment is more important than ever. “We know from safety engineering principles that just relying on vigilance is not a long-term safety strategy,” says Aaron Zach Hettinger, MD, chief research information officer at MedStar Health Research Institute, Washington, D.C. “So, it’s critical that we design these safe systems and leverage the data that’s in them.”
Here are five smart EHR practices to help protect your patients’ health and your own liability.
1. Double-check dropdown boxes
When it comes to user error, it’s easy to click the wrong choice from a drop-down menu. Better to take the time to explain your answer in a box, even if it takes a few more minutes. Or if you are choosing from a menu, proofread any information it auto-fills in the chart.
Dr. Hettinger says you can strike a balance between these templated approaches to diagnosis and long-term care by working with third-party systems and your organization or vendor IT department to help with follow-up questions to keep populated data in check.
“Make sure you have a back-end system that can help monitor that structured data,” says Dr. Hettinger. Structured data are the patient’s demographic information, like name, address, age, height, weight, vital signs, and data elements like diagnosis, medications, and lab results. “Wherever you can leverage the underlying tools that are part of the electronic health record to make sure that we’re constantly checking the right results, that helps reduce the workload so that clinicians can focus on taking care of the patients and doing the right thing and not be as focused on entering data into the system.”
2. Supplement EHR notes with direct communication
The failure to diagnose cancer because one physician doesn’t know what another physician saw in an imaging report is one of the most common claims in the cases he tries, says Aaron Boeder, a plaintiff’s medical negligence lawyer in Chicago.
Physicians often assume that if they put a note in the electronic chart, others will look for it, but Mr. Boeder says it’s far more prudent to communicate directly.
“Let’s say a radiologist interprets a scan and sees what might be cancer,” he says. “If the ordering doctor is an orthopedist who’s ordered a CT scan for DVT, there’s going to be a report for that scan. It’s going to get auto-populated back into that physician’s note,” says Mr. Boeder.
The physician may or may not look at it, but it will be in their note, and they’re supposed to follow up on it because they ordered the scan. “But they may not follow up on it, and they may not get a call from the radiologist,” he says.
“Next thing you know, 2 or 3 years later, that patient is diagnosed with very advanced cancer.”
3. Tailor auto-fill information to your common practices
Suppose, as a physician, you find that you need to change a default setting time and time again. Dr. Hettinger says it’s worth your time to take an extra couple of minutes to work with your vendor or your health system to try and make changes to auto-population settings that align with your practices.
“Let’s say a default dose of 20 milligrams of a medication is what automatically pops up, but in reality, your practice is to use a smaller dose because it’s safer, even though they’re all within the acceptable realm of what you would order,” he says. “Rather than have the default to the higher dose, see if you can change the default to a lower dose. And that way, you don’t have to catch yourself every time.”
If your auto-fills are amounts that constantly need changing, an interruption could easily knock you off course before you make that correction.
“If there are ways to have the system defaults be safer or more in line with your clinical practice, and especially across a group, then you’re designing a safer system and not relying on vigilance or memory prone to interruptions,” says Dr. Hettinger.
4. Curb the copy and paste
It’s tempting to copy a note from a previous patient visit and make only minimal changes as needed, but you risk including outdated information if you do. Even if you’re repeating questions asked by the intake nurse, it is safer to not to rely on that information, says Beth Kanik, a defense medical malpractice attorney in Atlanta.
“If it later goes into litigation, the argument then becomes that it looks like you didn’t do your job,” says Ms. Kanik. “Instead, try to ask questions in a way that would elicit responses that may be a little different than what the nurse got, so that it’s clear you asked the questions and didn’t just simply rely upon someone else’s information.”
5. Separate typing from listening
While EHR may be an excellent tool for data collection and safety checking, it’s not a stand-in for doctor-patient interaction. As technology practices push medicine toward more and more efficiency, Mr. Boeder says it’s most often listening over all else that makes the difference in the quality of care. And good listening requires full attention.
“A real concern for physicians is the number of visits they’re expected to accomplish in a set amount of time,” says Mr. Boeder. “Often this translates into a doctor talking to a patient while typing notes or while reading a note from the last time the patient was in.”
Taking the time to pause after entering data and briefly reviewing your understanding of what your patient has told you can be invaluable and may save you – and your patient – problems later.
“In so many cases, it comes down to people not being heard,” says Mr. Boeder. “So listen to what your patients are saying.”
A version of this article first appeared on Medscape.com.
Want to add a new partner to your practice? Here’s what to consider
When the match is right, the benefits can be significant: more hands to share the load of running a medical practice, and increased revenue and expanded patient population. A partner can bring in new, complementary strengths and skills. Adding a partner is also a way to prepare for the future by setting your practice up for a smooth transition if you or another partner is looking toward retirement.
But a mismatched partnership can cost you time and money, not to mention endless amount of conflict, dysfunction, and liability. Mutual trust and a long-term commitment on both sides are critical.
“Just like with marriage, it can be very difficult, traumatic, and expensive to break up with a partner,” said Clifton Straughn, MD, partner at Direct Access MD, a concierge-service model family practice in Anderson, S.C. “So, do your due diligence and take your time.” Picking the right partner is essential.
The basics
Before you begin the process of partnership with a physician, be sure you know what you need, the skill sets you’re looking for to complement your practice, and the personality characteristics and values that are important to you so the person you choose can check all the boxes and not just add a name to the letterhead.
“A lot of times, doctors go into this with just a general idea that they need more doctors or that they would like to be bigger or have more clout,” said Tim Boden, a certified medical practice executive with over 40 years of experience. “But you have to understand that to a certain degree, if you’re bringing somebody in who has basically an identical clinical profile to yours, you’re going to be sacrificing a bit of your lunch for a while until that person builds a name for himself or herself. A new partner’s skill set should match the need that you’re trying to fill.”
Figure out and discuss with your current partners how much it will cost to bring in a partner between their compensation and additional practice expenses. How much revenue will you expect the partner to generate? Will your practice break even the first year or the second? And how will you cover any shortfall?
It’s also essential to understand how the day-to-day operation of your practice will change after you add another partner.
- Will the new partner’s percentage of ownership be the same as that of the other partners?
- Will their ownership include a percentage of the facility, equipment, supplies, and accounts receivable?
- How will you split call and work hours?
- How will decision-making work?
- How would buyout work if a partner were to leave the practice, and is there a minimum obligation, such as a 5-year commitment?
As a team, you may also want to discuss “soft skills,” or the way you’d hope a partner would represent your practice to patients and the community.
“These can be harder to quantify,” said Dr. Straughn. “Evaluating them can take artful questions and simple observation over time.”
It’s a slow process
Many practices offer paths to partnership rather than bringing in a partner straight away. With this process, an incoming physician works toward that goal. If you’re going this route, discuss this during the hiring process, so that both sides are clear about the process. Rule No. 1 is to make sure that new hires understand that partnership is possible, although it’s not a given. The typical partnership track is 2-3 years, but you can set the timeline that works best for your practice.
Mr. Boden recommends at least a year for this period so as to allow you the opportunity to evaluate the new member, how they work, and how they fit with your team. The partnership track method is typically for young or fairly new physicians.
“I would avoid ever promising an ownership position to a recruit,” said Mr. Boden. “I would only show them how it can happen and what it would look like if they qualify.”
Consider professional help
If you want to be sure you weigh all the pros and cons of your new partner, a medical practice consultant may be the way to go. A consultant can identify many situations that you might overlook.
Some services offer a medical practice assessment to help you see where you need the most help and what skills might be best to bring to the table. They might also be able to take over some of the administrative work of a new hire if you like, so you and the other partners can focus solely on interacting with and observing the clinical abilities of a potential partner.
A health care attorney can help you build a sound agreement regarding decision-making and how the fees/costs will be divided and can put legal protections in place for everyone involved.
You’ll need a buy-sell agreement (also called a partnership or shareholder agreement) that spells out the terms and conditions, including buying into and selling out of the practice. A fair agreement respects all parties, while a poor one that offers the new partner a minority share or lessor profit may favor the practice’s current partners but could breed resentment, undermining the practice’s culture and morale.
Takeaway
Ideally, you’ll select someone with excellent credentials and experience with similar goals for the practice who blends well with your staff. It’s best to find someone who fits well culturally with your office and who practices medicine with a similar patient philosophy.
To that end, Mr. Boden encourages out-of-the-box questions for interviews, such as what a potential partner wants to make sure they have room for in their life, or what their ideal work and family life looks like. The more you can assess components such as emotional intelligence, =the fuller picture you’ll get.
“You’re going to be spending major hours every week with this person, and your destiny is going to be tied up with theirs to some degree,” said Mr. Boden. You can teach somebody the job, but if you don’t genuinely like and respect them and want to work with them daily, it may not be the right fit.
A version of this article first appeared on Medscape.com.
When the match is right, the benefits can be significant: more hands to share the load of running a medical practice, and increased revenue and expanded patient population. A partner can bring in new, complementary strengths and skills. Adding a partner is also a way to prepare for the future by setting your practice up for a smooth transition if you or another partner is looking toward retirement.
But a mismatched partnership can cost you time and money, not to mention endless amount of conflict, dysfunction, and liability. Mutual trust and a long-term commitment on both sides are critical.
“Just like with marriage, it can be very difficult, traumatic, and expensive to break up with a partner,” said Clifton Straughn, MD, partner at Direct Access MD, a concierge-service model family practice in Anderson, S.C. “So, do your due diligence and take your time.” Picking the right partner is essential.
The basics
Before you begin the process of partnership with a physician, be sure you know what you need, the skill sets you’re looking for to complement your practice, and the personality characteristics and values that are important to you so the person you choose can check all the boxes and not just add a name to the letterhead.
“A lot of times, doctors go into this with just a general idea that they need more doctors or that they would like to be bigger or have more clout,” said Tim Boden, a certified medical practice executive with over 40 years of experience. “But you have to understand that to a certain degree, if you’re bringing somebody in who has basically an identical clinical profile to yours, you’re going to be sacrificing a bit of your lunch for a while until that person builds a name for himself or herself. A new partner’s skill set should match the need that you’re trying to fill.”
Figure out and discuss with your current partners how much it will cost to bring in a partner between their compensation and additional practice expenses. How much revenue will you expect the partner to generate? Will your practice break even the first year or the second? And how will you cover any shortfall?
It’s also essential to understand how the day-to-day operation of your practice will change after you add another partner.
- Will the new partner’s percentage of ownership be the same as that of the other partners?
- Will their ownership include a percentage of the facility, equipment, supplies, and accounts receivable?
- How will you split call and work hours?
- How will decision-making work?
- How would buyout work if a partner were to leave the practice, and is there a minimum obligation, such as a 5-year commitment?
As a team, you may also want to discuss “soft skills,” or the way you’d hope a partner would represent your practice to patients and the community.
“These can be harder to quantify,” said Dr. Straughn. “Evaluating them can take artful questions and simple observation over time.”
It’s a slow process
Many practices offer paths to partnership rather than bringing in a partner straight away. With this process, an incoming physician works toward that goal. If you’re going this route, discuss this during the hiring process, so that both sides are clear about the process. Rule No. 1 is to make sure that new hires understand that partnership is possible, although it’s not a given. The typical partnership track is 2-3 years, but you can set the timeline that works best for your practice.
Mr. Boden recommends at least a year for this period so as to allow you the opportunity to evaluate the new member, how they work, and how they fit with your team. The partnership track method is typically for young or fairly new physicians.
“I would avoid ever promising an ownership position to a recruit,” said Mr. Boden. “I would only show them how it can happen and what it would look like if they qualify.”
Consider professional help
If you want to be sure you weigh all the pros and cons of your new partner, a medical practice consultant may be the way to go. A consultant can identify many situations that you might overlook.
Some services offer a medical practice assessment to help you see where you need the most help and what skills might be best to bring to the table. They might also be able to take over some of the administrative work of a new hire if you like, so you and the other partners can focus solely on interacting with and observing the clinical abilities of a potential partner.
A health care attorney can help you build a sound agreement regarding decision-making and how the fees/costs will be divided and can put legal protections in place for everyone involved.
You’ll need a buy-sell agreement (also called a partnership or shareholder agreement) that spells out the terms and conditions, including buying into and selling out of the practice. A fair agreement respects all parties, while a poor one that offers the new partner a minority share or lessor profit may favor the practice’s current partners but could breed resentment, undermining the practice’s culture and morale.
Takeaway
Ideally, you’ll select someone with excellent credentials and experience with similar goals for the practice who blends well with your staff. It’s best to find someone who fits well culturally with your office and who practices medicine with a similar patient philosophy.
To that end, Mr. Boden encourages out-of-the-box questions for interviews, such as what a potential partner wants to make sure they have room for in their life, or what their ideal work and family life looks like. The more you can assess components such as emotional intelligence, =the fuller picture you’ll get.
“You’re going to be spending major hours every week with this person, and your destiny is going to be tied up with theirs to some degree,” said Mr. Boden. You can teach somebody the job, but if you don’t genuinely like and respect them and want to work with them daily, it may not be the right fit.
A version of this article first appeared on Medscape.com.
When the match is right, the benefits can be significant: more hands to share the load of running a medical practice, and increased revenue and expanded patient population. A partner can bring in new, complementary strengths and skills. Adding a partner is also a way to prepare for the future by setting your practice up for a smooth transition if you or another partner is looking toward retirement.
But a mismatched partnership can cost you time and money, not to mention endless amount of conflict, dysfunction, and liability. Mutual trust and a long-term commitment on both sides are critical.
“Just like with marriage, it can be very difficult, traumatic, and expensive to break up with a partner,” said Clifton Straughn, MD, partner at Direct Access MD, a concierge-service model family practice in Anderson, S.C. “So, do your due diligence and take your time.” Picking the right partner is essential.
The basics
Before you begin the process of partnership with a physician, be sure you know what you need, the skill sets you’re looking for to complement your practice, and the personality characteristics and values that are important to you so the person you choose can check all the boxes and not just add a name to the letterhead.
“A lot of times, doctors go into this with just a general idea that they need more doctors or that they would like to be bigger or have more clout,” said Tim Boden, a certified medical practice executive with over 40 years of experience. “But you have to understand that to a certain degree, if you’re bringing somebody in who has basically an identical clinical profile to yours, you’re going to be sacrificing a bit of your lunch for a while until that person builds a name for himself or herself. A new partner’s skill set should match the need that you’re trying to fill.”
Figure out and discuss with your current partners how much it will cost to bring in a partner between their compensation and additional practice expenses. How much revenue will you expect the partner to generate? Will your practice break even the first year or the second? And how will you cover any shortfall?
It’s also essential to understand how the day-to-day operation of your practice will change after you add another partner.
- Will the new partner’s percentage of ownership be the same as that of the other partners?
- Will their ownership include a percentage of the facility, equipment, supplies, and accounts receivable?
- How will you split call and work hours?
- How will decision-making work?
- How would buyout work if a partner were to leave the practice, and is there a minimum obligation, such as a 5-year commitment?
As a team, you may also want to discuss “soft skills,” or the way you’d hope a partner would represent your practice to patients and the community.
“These can be harder to quantify,” said Dr. Straughn. “Evaluating them can take artful questions and simple observation over time.”
It’s a slow process
Many practices offer paths to partnership rather than bringing in a partner straight away. With this process, an incoming physician works toward that goal. If you’re going this route, discuss this during the hiring process, so that both sides are clear about the process. Rule No. 1 is to make sure that new hires understand that partnership is possible, although it’s not a given. The typical partnership track is 2-3 years, but you can set the timeline that works best for your practice.
Mr. Boden recommends at least a year for this period so as to allow you the opportunity to evaluate the new member, how they work, and how they fit with your team. The partnership track method is typically for young or fairly new physicians.
“I would avoid ever promising an ownership position to a recruit,” said Mr. Boden. “I would only show them how it can happen and what it would look like if they qualify.”
Consider professional help
If you want to be sure you weigh all the pros and cons of your new partner, a medical practice consultant may be the way to go. A consultant can identify many situations that you might overlook.
Some services offer a medical practice assessment to help you see where you need the most help and what skills might be best to bring to the table. They might also be able to take over some of the administrative work of a new hire if you like, so you and the other partners can focus solely on interacting with and observing the clinical abilities of a potential partner.
A health care attorney can help you build a sound agreement regarding decision-making and how the fees/costs will be divided and can put legal protections in place for everyone involved.
You’ll need a buy-sell agreement (also called a partnership or shareholder agreement) that spells out the terms and conditions, including buying into and selling out of the practice. A fair agreement respects all parties, while a poor one that offers the new partner a minority share or lessor profit may favor the practice’s current partners but could breed resentment, undermining the practice’s culture and morale.
Takeaway
Ideally, you’ll select someone with excellent credentials and experience with similar goals for the practice who blends well with your staff. It’s best to find someone who fits well culturally with your office and who practices medicine with a similar patient philosophy.
To that end, Mr. Boden encourages out-of-the-box questions for interviews, such as what a potential partner wants to make sure they have room for in their life, or what their ideal work and family life looks like. The more you can assess components such as emotional intelligence, =the fuller picture you’ll get.
“You’re going to be spending major hours every week with this person, and your destiny is going to be tied up with theirs to some degree,” said Mr. Boden. You can teach somebody the job, but if you don’t genuinely like and respect them and want to work with them daily, it may not be the right fit.
A version of this article first appeared on Medscape.com.
New bill would provide greater length of time to sue doctors
A bill in the Maine legislature would have the medical malpractice statute of limitations clock start running when a patient discovers the negligence, which could be years after treatment took place. And other states could follow suit with similar bills. What danger does this pose for doctors?
As it stands, the time limit for patients to be able to bring a medical malpractice lawsuit varies by state. For physicians, this extends their period of liability and could potentially increase the number of lawsuits against them.
“The theory behind a statute of limitations is that states want to provide a reasonable, but not indefinite, amount of time for someone to bring a case to court,” says Patrick T. O’Rourke, Esq., adjunct professor at University of Colorado School of Law, Boulder.
Without a statute of limitations, people could bring claims many years after the fact, which makes it harder to obtain and preserve evidence, Mr. O’Rourke says.
In most cases, it isn’t necessary for a patient to know the full extent of their injury or that their physician acted wrongfully or negligently for the statute of limitations to begin running.
Time of injury versus time of discovery
Most states’ laws dictate that the statute of limitations begins at a set time “after the cause of action accrues.” That means that the clock starts ticking from the date of the procedure, surgery, or treatment. In most states, that time is 2 or 3 years.
This can bar some patients from taking any action at all because the statute of limitations ran out. Because of these hurdles, the proposed bill in Maine would extend the statute of limitations.
Proponents of the bill say that patients would still have 3 years to file suit; it just changes when the clock starts. But opponents feel it could open the door to a limitless system in which people have an indefinite time to sue.
Many states already have discovery rules that extend the statute of limitations when the harm was not immediately obvious to the patient. The legal expectation is that patients who have significant pain or unexpected health conditions will seek medical treatment to investigate what’s wrong. Patients who don’t address the situation promptly are not protected by the discovery rule.
“It is the injured person’s obligation, once learning of the injury, to take action to protect their rights,” says Mr. O’Rourke.
Some states have also enacted other claims requirements in medical malpractice cases that are prerequisites for bringing lawsuits that have periods attached to them. For instance, in Florida, parties have 10 days to provide relevant medical records during the investigation period for a malpractice suit, and in Maine, before filing any malpractice action, a plaintiff must file a complaint with a prelitigation screening panel.
Medical malpractice statutes of limitations by state
Although each state has a basic statute of limitations, many states also include clauses for discovery rules. For example, in Vermont, in addition to the 3-year statute of limitations, a patient can pursue legal recourse “2 years from the date the injury is or reasonably should have been discovered, whichever occurs later, but not later than 7 years from the date of the incident.”
In some states, such as Virginia, special extensions apply in cases in which fraud, concealment, or intentional misrepresentation prevented discovery of the injury within the statute of limitations. And in most states, the statute of limitations is much longer for cases in which medical malpractice involves a child, usually at least until the child turns 18.
Statutes of limitations by state
1 Year: California, Kentucky, Louisiana, Ohio, Tennessee
2 Years: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Utah, Virginia, West Virginia, Wyoming
2.5 Years: New York
3 Years: Washington D.C., Maine, Maryland, Massachusetts, Montana, Nevada, New Mexico, North Carolina, Rhode Island, South Carolina, Vermont, Washington, Wisconsin
4 Years: Minnesota
To protect yourself
Mr. O’Rourke says that if your state enacts a law that extends the statute of limitations for medical malpractice, there aren’t any proactive changes you need to make in terms of your day-to-day practice of medicine.
“Physicians should continue to provide care that is consistent with the standards of care for their specialty and ensure that the documentation accurately reflects the care they rendered,” he says.
Always be candid and up-front about a patient’s condition, Mr. O’Rourke says, especially if malpractice is on the table.
“If a physician misleads a patient about the nature or extent of an injury, that could prevent the statute of limitations from beginning to run,” he says. “Being open and honest about an injury doesn’t mean that a physician must admit any fault. The patient is owed timely, accurate, and candid information about their condition.”
Keep good records
If the statute of limitations increases, you’ll need to have access to the medical records for as long as the statute is in place, but this shouldn’t have an effect on your records keeping if you’re up to date with HIPAA compliance, says Mr. O’Rourke.
“I don’t think an extension of the statute should cause physicians to change their practices, particularly with the retention of medical records, which should be maintained consistently with HIPAA requirements irrespective of the limitations period in a particular state,” he adds.
Keep an eye on malpractice insurance rates
It’s possible that your malpractice insurance could go up as a result of laws that increase the statute of limitations. But Mr. O’Rourke thinks it likely won’t be a significant amount.
He says it’s “theoretically possible” that an increase in a limitations period could result in an increase in your malpractice insurance, since some claims that would otherwise have been barred because of time could then proceed, but the increase would be nominal.
“I would expect any increase to be fairly marginal because the majority of claims will already be accounted for on an actuarial basis,” he says. “I also don’t think that the extension of a limitations period would increase the award of damages in a particular case. The injuries should be the same under either limitations period, so the compensable loss should not increase.”
Anything that makes it easier for patients to recover should increase the cost of professional liability insurance, and vice versa, says Charles Silver, McDonald Endowed Chair in Civil Procedure at University of Texas at Austin School of Law and coauthor of “Medical Malpractice Litigation: How It Works – Why Tort Reform Hasn’t Helped.” But the long-term trend across the country is toward declining rates of liability and declining payouts on claims.
“The likelihood of being sued successfully by a former patient is low, as is the risk of having to pay out of pocket to settle a claim,” he says. In 2022, the number of adverse reports nationally was 38,938, and out of those, 10,807 resulted in a payout.
In his research on medical malpractice in Texas, Mr. Silver says physicians who carried $1 million in coverage essentially never faced any personal liability on medical malpractice claims. “[This means] that they never had to write a check to a victim,” he says. “Insurers provided all the money. I suspect that the same is true nationwide.”
Key takeaways
Ultimately, to protect yourself and your practice, you can do the following:
- Know the statute of limitations and discovery rules for your state.
- Review your coverage with your insurer to better understand your liability.
- Keep accurate records for as long as your statute requires.
- Notify your insurer or risk management department as soon as possible in the event of an adverse outcome with a patient, Mr. O’Rourke advises.
“The most important thing a physician can do to avoid being sued, even when negligent, is to treat patients with kindness and respect,” says Mr. Silver. “Patients don’t expect doctors to be perfect, and they rarely sue doctors they like.”
A version of this article first appeared on Medscape.com.
A bill in the Maine legislature would have the medical malpractice statute of limitations clock start running when a patient discovers the negligence, which could be years after treatment took place. And other states could follow suit with similar bills. What danger does this pose for doctors?
As it stands, the time limit for patients to be able to bring a medical malpractice lawsuit varies by state. For physicians, this extends their period of liability and could potentially increase the number of lawsuits against them.
“The theory behind a statute of limitations is that states want to provide a reasonable, but not indefinite, amount of time for someone to bring a case to court,” says Patrick T. O’Rourke, Esq., adjunct professor at University of Colorado School of Law, Boulder.
Without a statute of limitations, people could bring claims many years after the fact, which makes it harder to obtain and preserve evidence, Mr. O’Rourke says.
In most cases, it isn’t necessary for a patient to know the full extent of their injury or that their physician acted wrongfully or negligently for the statute of limitations to begin running.
Time of injury versus time of discovery
Most states’ laws dictate that the statute of limitations begins at a set time “after the cause of action accrues.” That means that the clock starts ticking from the date of the procedure, surgery, or treatment. In most states, that time is 2 or 3 years.
This can bar some patients from taking any action at all because the statute of limitations ran out. Because of these hurdles, the proposed bill in Maine would extend the statute of limitations.
Proponents of the bill say that patients would still have 3 years to file suit; it just changes when the clock starts. But opponents feel it could open the door to a limitless system in which people have an indefinite time to sue.
Many states already have discovery rules that extend the statute of limitations when the harm was not immediately obvious to the patient. The legal expectation is that patients who have significant pain or unexpected health conditions will seek medical treatment to investigate what’s wrong. Patients who don’t address the situation promptly are not protected by the discovery rule.
“It is the injured person’s obligation, once learning of the injury, to take action to protect their rights,” says Mr. O’Rourke.
Some states have also enacted other claims requirements in medical malpractice cases that are prerequisites for bringing lawsuits that have periods attached to them. For instance, in Florida, parties have 10 days to provide relevant medical records during the investigation period for a malpractice suit, and in Maine, before filing any malpractice action, a plaintiff must file a complaint with a prelitigation screening panel.
Medical malpractice statutes of limitations by state
Although each state has a basic statute of limitations, many states also include clauses for discovery rules. For example, in Vermont, in addition to the 3-year statute of limitations, a patient can pursue legal recourse “2 years from the date the injury is or reasonably should have been discovered, whichever occurs later, but not later than 7 years from the date of the incident.”
In some states, such as Virginia, special extensions apply in cases in which fraud, concealment, or intentional misrepresentation prevented discovery of the injury within the statute of limitations. And in most states, the statute of limitations is much longer for cases in which medical malpractice involves a child, usually at least until the child turns 18.
Statutes of limitations by state
1 Year: California, Kentucky, Louisiana, Ohio, Tennessee
2 Years: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Utah, Virginia, West Virginia, Wyoming
2.5 Years: New York
3 Years: Washington D.C., Maine, Maryland, Massachusetts, Montana, Nevada, New Mexico, North Carolina, Rhode Island, South Carolina, Vermont, Washington, Wisconsin
4 Years: Minnesota
To protect yourself
Mr. O’Rourke says that if your state enacts a law that extends the statute of limitations for medical malpractice, there aren’t any proactive changes you need to make in terms of your day-to-day practice of medicine.
“Physicians should continue to provide care that is consistent with the standards of care for their specialty and ensure that the documentation accurately reflects the care they rendered,” he says.
Always be candid and up-front about a patient’s condition, Mr. O’Rourke says, especially if malpractice is on the table.
“If a physician misleads a patient about the nature or extent of an injury, that could prevent the statute of limitations from beginning to run,” he says. “Being open and honest about an injury doesn’t mean that a physician must admit any fault. The patient is owed timely, accurate, and candid information about their condition.”
Keep good records
If the statute of limitations increases, you’ll need to have access to the medical records for as long as the statute is in place, but this shouldn’t have an effect on your records keeping if you’re up to date with HIPAA compliance, says Mr. O’Rourke.
“I don’t think an extension of the statute should cause physicians to change their practices, particularly with the retention of medical records, which should be maintained consistently with HIPAA requirements irrespective of the limitations period in a particular state,” he adds.
Keep an eye on malpractice insurance rates
It’s possible that your malpractice insurance could go up as a result of laws that increase the statute of limitations. But Mr. O’Rourke thinks it likely won’t be a significant amount.
He says it’s “theoretically possible” that an increase in a limitations period could result in an increase in your malpractice insurance, since some claims that would otherwise have been barred because of time could then proceed, but the increase would be nominal.
“I would expect any increase to be fairly marginal because the majority of claims will already be accounted for on an actuarial basis,” he says. “I also don’t think that the extension of a limitations period would increase the award of damages in a particular case. The injuries should be the same under either limitations period, so the compensable loss should not increase.”
Anything that makes it easier for patients to recover should increase the cost of professional liability insurance, and vice versa, says Charles Silver, McDonald Endowed Chair in Civil Procedure at University of Texas at Austin School of Law and coauthor of “Medical Malpractice Litigation: How It Works – Why Tort Reform Hasn’t Helped.” But the long-term trend across the country is toward declining rates of liability and declining payouts on claims.
“The likelihood of being sued successfully by a former patient is low, as is the risk of having to pay out of pocket to settle a claim,” he says. In 2022, the number of adverse reports nationally was 38,938, and out of those, 10,807 resulted in a payout.
In his research on medical malpractice in Texas, Mr. Silver says physicians who carried $1 million in coverage essentially never faced any personal liability on medical malpractice claims. “[This means] that they never had to write a check to a victim,” he says. “Insurers provided all the money. I suspect that the same is true nationwide.”
Key takeaways
Ultimately, to protect yourself and your practice, you can do the following:
- Know the statute of limitations and discovery rules for your state.
- Review your coverage with your insurer to better understand your liability.
- Keep accurate records for as long as your statute requires.
- Notify your insurer or risk management department as soon as possible in the event of an adverse outcome with a patient, Mr. O’Rourke advises.
“The most important thing a physician can do to avoid being sued, even when negligent, is to treat patients with kindness and respect,” says Mr. Silver. “Patients don’t expect doctors to be perfect, and they rarely sue doctors they like.”
A version of this article first appeared on Medscape.com.
A bill in the Maine legislature would have the medical malpractice statute of limitations clock start running when a patient discovers the negligence, which could be years after treatment took place. And other states could follow suit with similar bills. What danger does this pose for doctors?
As it stands, the time limit for patients to be able to bring a medical malpractice lawsuit varies by state. For physicians, this extends their period of liability and could potentially increase the number of lawsuits against them.
“The theory behind a statute of limitations is that states want to provide a reasonable, but not indefinite, amount of time for someone to bring a case to court,” says Patrick T. O’Rourke, Esq., adjunct professor at University of Colorado School of Law, Boulder.
Without a statute of limitations, people could bring claims many years after the fact, which makes it harder to obtain and preserve evidence, Mr. O’Rourke says.
In most cases, it isn’t necessary for a patient to know the full extent of their injury or that their physician acted wrongfully or negligently for the statute of limitations to begin running.
Time of injury versus time of discovery
Most states’ laws dictate that the statute of limitations begins at a set time “after the cause of action accrues.” That means that the clock starts ticking from the date of the procedure, surgery, or treatment. In most states, that time is 2 or 3 years.
This can bar some patients from taking any action at all because the statute of limitations ran out. Because of these hurdles, the proposed bill in Maine would extend the statute of limitations.
Proponents of the bill say that patients would still have 3 years to file suit; it just changes when the clock starts. But opponents feel it could open the door to a limitless system in which people have an indefinite time to sue.
Many states already have discovery rules that extend the statute of limitations when the harm was not immediately obvious to the patient. The legal expectation is that patients who have significant pain or unexpected health conditions will seek medical treatment to investigate what’s wrong. Patients who don’t address the situation promptly are not protected by the discovery rule.
“It is the injured person’s obligation, once learning of the injury, to take action to protect their rights,” says Mr. O’Rourke.
Some states have also enacted other claims requirements in medical malpractice cases that are prerequisites for bringing lawsuits that have periods attached to them. For instance, in Florida, parties have 10 days to provide relevant medical records during the investigation period for a malpractice suit, and in Maine, before filing any malpractice action, a plaintiff must file a complaint with a prelitigation screening panel.
Medical malpractice statutes of limitations by state
Although each state has a basic statute of limitations, many states also include clauses for discovery rules. For example, in Vermont, in addition to the 3-year statute of limitations, a patient can pursue legal recourse “2 years from the date the injury is or reasonably should have been discovered, whichever occurs later, but not later than 7 years from the date of the incident.”
In some states, such as Virginia, special extensions apply in cases in which fraud, concealment, or intentional misrepresentation prevented discovery of the injury within the statute of limitations. And in most states, the statute of limitations is much longer for cases in which medical malpractice involves a child, usually at least until the child turns 18.
Statutes of limitations by state
1 Year: California, Kentucky, Louisiana, Ohio, Tennessee
2 Years: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Utah, Virginia, West Virginia, Wyoming
2.5 Years: New York
3 Years: Washington D.C., Maine, Maryland, Massachusetts, Montana, Nevada, New Mexico, North Carolina, Rhode Island, South Carolina, Vermont, Washington, Wisconsin
4 Years: Minnesota
To protect yourself
Mr. O’Rourke says that if your state enacts a law that extends the statute of limitations for medical malpractice, there aren’t any proactive changes you need to make in terms of your day-to-day practice of medicine.
“Physicians should continue to provide care that is consistent with the standards of care for their specialty and ensure that the documentation accurately reflects the care they rendered,” he says.
Always be candid and up-front about a patient’s condition, Mr. O’Rourke says, especially if malpractice is on the table.
“If a physician misleads a patient about the nature or extent of an injury, that could prevent the statute of limitations from beginning to run,” he says. “Being open and honest about an injury doesn’t mean that a physician must admit any fault. The patient is owed timely, accurate, and candid information about their condition.”
Keep good records
If the statute of limitations increases, you’ll need to have access to the medical records for as long as the statute is in place, but this shouldn’t have an effect on your records keeping if you’re up to date with HIPAA compliance, says Mr. O’Rourke.
“I don’t think an extension of the statute should cause physicians to change their practices, particularly with the retention of medical records, which should be maintained consistently with HIPAA requirements irrespective of the limitations period in a particular state,” he adds.
Keep an eye on malpractice insurance rates
It’s possible that your malpractice insurance could go up as a result of laws that increase the statute of limitations. But Mr. O’Rourke thinks it likely won’t be a significant amount.
He says it’s “theoretically possible” that an increase in a limitations period could result in an increase in your malpractice insurance, since some claims that would otherwise have been barred because of time could then proceed, but the increase would be nominal.
“I would expect any increase to be fairly marginal because the majority of claims will already be accounted for on an actuarial basis,” he says. “I also don’t think that the extension of a limitations period would increase the award of damages in a particular case. The injuries should be the same under either limitations period, so the compensable loss should not increase.”
Anything that makes it easier for patients to recover should increase the cost of professional liability insurance, and vice versa, says Charles Silver, McDonald Endowed Chair in Civil Procedure at University of Texas at Austin School of Law and coauthor of “Medical Malpractice Litigation: How It Works – Why Tort Reform Hasn’t Helped.” But the long-term trend across the country is toward declining rates of liability and declining payouts on claims.
“The likelihood of being sued successfully by a former patient is low, as is the risk of having to pay out of pocket to settle a claim,” he says. In 2022, the number of adverse reports nationally was 38,938, and out of those, 10,807 resulted in a payout.
In his research on medical malpractice in Texas, Mr. Silver says physicians who carried $1 million in coverage essentially never faced any personal liability on medical malpractice claims. “[This means] that they never had to write a check to a victim,” he says. “Insurers provided all the money. I suspect that the same is true nationwide.”
Key takeaways
Ultimately, to protect yourself and your practice, you can do the following:
- Know the statute of limitations and discovery rules for your state.
- Review your coverage with your insurer to better understand your liability.
- Keep accurate records for as long as your statute requires.
- Notify your insurer or risk management department as soon as possible in the event of an adverse outcome with a patient, Mr. O’Rourke advises.
“The most important thing a physician can do to avoid being sued, even when negligent, is to treat patients with kindness and respect,” says Mr. Silver. “Patients don’t expect doctors to be perfect, and they rarely sue doctors they like.”
A version of this article first appeared on Medscape.com.
Empathy meltdown? Why burnout busts your empathy levels
Compassion is borne out of a sense of empathy – the ability to understand and share the feelings of others. Studies on empathy show it to be crucial to quality health care and not just for patients.
In one study on empathy ratings among doctors, 87% of the public believe that compassion, or a clear and obvious desire to relieve suffering, is the most critical factor when choosing a doctor. In fact, it eclipses travel time, wait time, and cost on the list of sought-after physician features.
Wendie Trubow, MD, an ob.gyn. in Newton, Mass., with over 25 years of experience in the medical field, says empathy has absolutely helped her be a better physician.
“Patients consistently mention how grateful they are that someone has listened to them and validated them,” she says. “When patients feel heard and validated, they are more likely to communicate openly, and this raises the potential of being able to create treatment plans that they will actually participate in. Ultimately, it enriches patient care.”
Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior at the Asano-Gonnella Center for Research in Medical Education and Health Care at Thomas Jefferson University in Philadelphia, says that empirical research he and colleagues have done on empathy in health profession education and patient care over the past 20 years shows that empathic engagement in patient care is reciprocally beneficial for both clinicians and patients.
For example, Dr. Hojat notes that in one study, diabetic patients treated by empathic physicians (measured by the Jefferson Scale of Empathy) had more control over their disease when measured with laboratory test results such as hemoglobin A1c and LDL-C. In another, patients with diabetes treated by more empathic physicians had significantly lower rates of acute metabolic complications that required hospitalization.
For physicians, empathic relationships with your patients lead to fewer disputes, higher reimbursements, greater patient satisfaction, fewer malpractice lawsuits, and a more rewarding experience treating patients.
Different types of empathy
The importance of empathy in doctoring is evident, but Dr. Hojat says it’s crucial to differentiate between clinical empathy and emotional empathy. One can enhance care, while the other, when overused, may lead to physician burnout.
In fact, he says, clinical empathy and emotional empathy have different consequences in a medical setting.
“The relationship between clinical empathy and clinical outcomes is linear, meaning that more empathic engagement leads to more positive clinical outcomes,” says Dr. Hojat. “However, the relationship between emotional empathy and clinical outcomes is curvilinear, or an inverted U shape, similar to the association between anxiety and performance, meaning that limited emotional empathy or limited sympathetic engagement could be helpful, but its overabundance can hamper clinical relationships and objective clinical decision-making.”
The takeaway is that when physicians don’t regulate their emotional empathy, it becomes an obstacle to clinical empathy, ultimately detrimental to health care outcomes.
When burnout hinders empathy
Of course, the reverse is also true – burnout can make it harder for physicians to muster up empathy of any kind toward their patients. At least 53% of physicians show one or more symptoms of burnout, such as exhaustion, questioning the point of the work, cynicism, sarcasm, and the need to “vent” about patients or the job, according to Medscape’s ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.
Venting about patients can also be called “compassion fatigue,” which is a sign that your ability to empathize with patients is compromised. You can still practice medicine, but you’re not operating anywhere close to your optimum abilities.
“Generally, physicians who are burned out struggle with empathy since it’s exactly what they’re missing for themselves, and [they] often find it difficult to generate,” says Dr. Trubow.
How to manage burnout and boost your empathy
Burnout can happen for various reasons – pressure to cycle through scores of patients, too many bureaucratic tasks, less autonomy, frustration with electronic health record requirements, and too many work hours, according to the Medscape report.
A report in Family Practice Management finds there are two main goals for physicians to tackle when trying to reduce burnout symptoms: Lower your stress levels and improve your ability to recharge your energy accounts.
“For physicians experiencing burnout [and thus, a lack of empathy], the best approach to this situation is to first take a break and evaluate whether there are any structures to put in place to improve the situation; this can often improve a provider’s empathy,” says Dr. Trubow.
For example, physicians can look at ways to alleviate burnout by investing in leadership development, finding flexible work arrangements, reducing technological burdens, and limiting nonclinical activities.
Other strategies that can build up your reserves include connecting with colleagues, gaining a greater sense of control over your work, and having opportunities to grow and excel in your field. This requires not only a personal approach by physicians, but a buy-in at an institutional level as well.
In Medscape’s report, where 65% of physicians say burnout affects their relationships, physicians’ coping methods include exercise, time with family and friends, time alone, sleep, music, and meditation.
“Clinical empathy must be placed in the realm of ‘evidence-based’ medicine,” says Dr. Hojat. “Given our research findings that clinical empathy tends to erode as students progress through medical school, it is important that assessment and enhancement of clinical empathy be integrated into formal educational curriculum of medical schools and postgraduate training programs for professional development of physicians–in-training and –in-practice.”
“Burnout also leads to a large swath of physicians who aren’t as empathetic toward their patients as they could be.”
–Danielle Ofri, “What Doctors Feel: How Emotions Affect the Practice of Medicine”.
A version of this article first appeared on Medscape.com.
Compassion is borne out of a sense of empathy – the ability to understand and share the feelings of others. Studies on empathy show it to be crucial to quality health care and not just for patients.
In one study on empathy ratings among doctors, 87% of the public believe that compassion, or a clear and obvious desire to relieve suffering, is the most critical factor when choosing a doctor. In fact, it eclipses travel time, wait time, and cost on the list of sought-after physician features.
Wendie Trubow, MD, an ob.gyn. in Newton, Mass., with over 25 years of experience in the medical field, says empathy has absolutely helped her be a better physician.
“Patients consistently mention how grateful they are that someone has listened to them and validated them,” she says. “When patients feel heard and validated, they are more likely to communicate openly, and this raises the potential of being able to create treatment plans that they will actually participate in. Ultimately, it enriches patient care.”
Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior at the Asano-Gonnella Center for Research in Medical Education and Health Care at Thomas Jefferson University in Philadelphia, says that empirical research he and colleagues have done on empathy in health profession education and patient care over the past 20 years shows that empathic engagement in patient care is reciprocally beneficial for both clinicians and patients.
For example, Dr. Hojat notes that in one study, diabetic patients treated by empathic physicians (measured by the Jefferson Scale of Empathy) had more control over their disease when measured with laboratory test results such as hemoglobin A1c and LDL-C. In another, patients with diabetes treated by more empathic physicians had significantly lower rates of acute metabolic complications that required hospitalization.
For physicians, empathic relationships with your patients lead to fewer disputes, higher reimbursements, greater patient satisfaction, fewer malpractice lawsuits, and a more rewarding experience treating patients.
Different types of empathy
The importance of empathy in doctoring is evident, but Dr. Hojat says it’s crucial to differentiate between clinical empathy and emotional empathy. One can enhance care, while the other, when overused, may lead to physician burnout.
In fact, he says, clinical empathy and emotional empathy have different consequences in a medical setting.
“The relationship between clinical empathy and clinical outcomes is linear, meaning that more empathic engagement leads to more positive clinical outcomes,” says Dr. Hojat. “However, the relationship between emotional empathy and clinical outcomes is curvilinear, or an inverted U shape, similar to the association between anxiety and performance, meaning that limited emotional empathy or limited sympathetic engagement could be helpful, but its overabundance can hamper clinical relationships and objective clinical decision-making.”
The takeaway is that when physicians don’t regulate their emotional empathy, it becomes an obstacle to clinical empathy, ultimately detrimental to health care outcomes.
When burnout hinders empathy
Of course, the reverse is also true – burnout can make it harder for physicians to muster up empathy of any kind toward their patients. At least 53% of physicians show one or more symptoms of burnout, such as exhaustion, questioning the point of the work, cynicism, sarcasm, and the need to “vent” about patients or the job, according to Medscape’s ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.
Venting about patients can also be called “compassion fatigue,” which is a sign that your ability to empathize with patients is compromised. You can still practice medicine, but you’re not operating anywhere close to your optimum abilities.
“Generally, physicians who are burned out struggle with empathy since it’s exactly what they’re missing for themselves, and [they] often find it difficult to generate,” says Dr. Trubow.
How to manage burnout and boost your empathy
Burnout can happen for various reasons – pressure to cycle through scores of patients, too many bureaucratic tasks, less autonomy, frustration with electronic health record requirements, and too many work hours, according to the Medscape report.
A report in Family Practice Management finds there are two main goals for physicians to tackle when trying to reduce burnout symptoms: Lower your stress levels and improve your ability to recharge your energy accounts.
“For physicians experiencing burnout [and thus, a lack of empathy], the best approach to this situation is to first take a break and evaluate whether there are any structures to put in place to improve the situation; this can often improve a provider’s empathy,” says Dr. Trubow.
For example, physicians can look at ways to alleviate burnout by investing in leadership development, finding flexible work arrangements, reducing technological burdens, and limiting nonclinical activities.
Other strategies that can build up your reserves include connecting with colleagues, gaining a greater sense of control over your work, and having opportunities to grow and excel in your field. This requires not only a personal approach by physicians, but a buy-in at an institutional level as well.
In Medscape’s report, where 65% of physicians say burnout affects their relationships, physicians’ coping methods include exercise, time with family and friends, time alone, sleep, music, and meditation.
“Clinical empathy must be placed in the realm of ‘evidence-based’ medicine,” says Dr. Hojat. “Given our research findings that clinical empathy tends to erode as students progress through medical school, it is important that assessment and enhancement of clinical empathy be integrated into formal educational curriculum of medical schools and postgraduate training programs for professional development of physicians–in-training and –in-practice.”
“Burnout also leads to a large swath of physicians who aren’t as empathetic toward their patients as they could be.”
–Danielle Ofri, “What Doctors Feel: How Emotions Affect the Practice of Medicine”.
A version of this article first appeared on Medscape.com.
Compassion is borne out of a sense of empathy – the ability to understand and share the feelings of others. Studies on empathy show it to be crucial to quality health care and not just for patients.
In one study on empathy ratings among doctors, 87% of the public believe that compassion, or a clear and obvious desire to relieve suffering, is the most critical factor when choosing a doctor. In fact, it eclipses travel time, wait time, and cost on the list of sought-after physician features.
Wendie Trubow, MD, an ob.gyn. in Newton, Mass., with over 25 years of experience in the medical field, says empathy has absolutely helped her be a better physician.
“Patients consistently mention how grateful they are that someone has listened to them and validated them,” she says. “When patients feel heard and validated, they are more likely to communicate openly, and this raises the potential of being able to create treatment plans that they will actually participate in. Ultimately, it enriches patient care.”
Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior at the Asano-Gonnella Center for Research in Medical Education and Health Care at Thomas Jefferson University in Philadelphia, says that empirical research he and colleagues have done on empathy in health profession education and patient care over the past 20 years shows that empathic engagement in patient care is reciprocally beneficial for both clinicians and patients.
For example, Dr. Hojat notes that in one study, diabetic patients treated by empathic physicians (measured by the Jefferson Scale of Empathy) had more control over their disease when measured with laboratory test results such as hemoglobin A1c and LDL-C. In another, patients with diabetes treated by more empathic physicians had significantly lower rates of acute metabolic complications that required hospitalization.
For physicians, empathic relationships with your patients lead to fewer disputes, higher reimbursements, greater patient satisfaction, fewer malpractice lawsuits, and a more rewarding experience treating patients.
Different types of empathy
The importance of empathy in doctoring is evident, but Dr. Hojat says it’s crucial to differentiate between clinical empathy and emotional empathy. One can enhance care, while the other, when overused, may lead to physician burnout.
In fact, he says, clinical empathy and emotional empathy have different consequences in a medical setting.
“The relationship between clinical empathy and clinical outcomes is linear, meaning that more empathic engagement leads to more positive clinical outcomes,” says Dr. Hojat. “However, the relationship between emotional empathy and clinical outcomes is curvilinear, or an inverted U shape, similar to the association between anxiety and performance, meaning that limited emotional empathy or limited sympathetic engagement could be helpful, but its overabundance can hamper clinical relationships and objective clinical decision-making.”
The takeaway is that when physicians don’t regulate their emotional empathy, it becomes an obstacle to clinical empathy, ultimately detrimental to health care outcomes.
When burnout hinders empathy
Of course, the reverse is also true – burnout can make it harder for physicians to muster up empathy of any kind toward their patients. At least 53% of physicians show one or more symptoms of burnout, such as exhaustion, questioning the point of the work, cynicism, sarcasm, and the need to “vent” about patients or the job, according to Medscape’s ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.
Venting about patients can also be called “compassion fatigue,” which is a sign that your ability to empathize with patients is compromised. You can still practice medicine, but you’re not operating anywhere close to your optimum abilities.
“Generally, physicians who are burned out struggle with empathy since it’s exactly what they’re missing for themselves, and [they] often find it difficult to generate,” says Dr. Trubow.
How to manage burnout and boost your empathy
Burnout can happen for various reasons – pressure to cycle through scores of patients, too many bureaucratic tasks, less autonomy, frustration with electronic health record requirements, and too many work hours, according to the Medscape report.
A report in Family Practice Management finds there are two main goals for physicians to tackle when trying to reduce burnout symptoms: Lower your stress levels and improve your ability to recharge your energy accounts.
“For physicians experiencing burnout [and thus, a lack of empathy], the best approach to this situation is to first take a break and evaluate whether there are any structures to put in place to improve the situation; this can often improve a provider’s empathy,” says Dr. Trubow.
For example, physicians can look at ways to alleviate burnout by investing in leadership development, finding flexible work arrangements, reducing technological burdens, and limiting nonclinical activities.
Other strategies that can build up your reserves include connecting with colleagues, gaining a greater sense of control over your work, and having opportunities to grow and excel in your field. This requires not only a personal approach by physicians, but a buy-in at an institutional level as well.
In Medscape’s report, where 65% of physicians say burnout affects their relationships, physicians’ coping methods include exercise, time with family and friends, time alone, sleep, music, and meditation.
“Clinical empathy must be placed in the realm of ‘evidence-based’ medicine,” says Dr. Hojat. “Given our research findings that clinical empathy tends to erode as students progress through medical school, it is important that assessment and enhancement of clinical empathy be integrated into formal educational curriculum of medical schools and postgraduate training programs for professional development of physicians–in-training and –in-practice.”
“Burnout also leads to a large swath of physicians who aren’t as empathetic toward their patients as they could be.”
–Danielle Ofri, “What Doctors Feel: How Emotions Affect the Practice of Medicine”.
A version of this article first appeared on Medscape.com.
What to do when patients don’t listen
The term “nonadherent” has gradually replaced “noncompliant” in the physician lexicon as a nod to the evolving doctor-patient relationship. Noncompliance implies that a patient isn’t following their doctor’s orders. Adherence, on the other hand, is a measure of how closely your patient’s behavior matches the recommendations you’ve made. It’s a subtle difference but an important distinction in approaching care.
“Noncompliance is inherently negative feedback to the patient, whereas there’s a reason for nonadherence, and it’s usually external,” said Sharon Rabinovitz, MD, president of the Georgia Academy of Family Physicians.
Why won’t patients listen?
The reasons behind a patient’s nonadherence are multifaceted, but they are often driven by social determinants of health, such as transportation, poor health literacy, finances, and lack of access to pharmacies.
Other times, patients don’t want to take medicine, don’t prioritize their health, or they find the dietary and lifestyle modifications doctors suggest too hard to make or they struggle at losing weight, eating more healthfully, or cutting back on alcohol, for instance.
“When you come down to it, the big hindrance of it all is cost and the ability for the patient to be able to afford some of the things that we think they should be able to do,” said Teresa Lovins, MD, a physician in private practice Columbus, Ind., and a member of the board of directors of the American Academy of Family Physicians.
Another common deterrent to treatment is undesired side effects that a patient may not want to mention.
“For example, a lot of patients who are taking antidepressants have sexual dysfunction associated with those medications,” said Dr. Rabinovitz. “If you don’t ask the right questions, you’re not going to be able to fully assess the experience the patient is having and a reason why they might not take it [the medication].”
Much nonadherence is intentional and is based on experience, belief systems, and knowledge. For example, the American Medical Association finds that patients may not understand why they need a certain treatment (and therefore dismiss it), or they may be overloaded with multiple medications, fear dependency on a drug, have a mistrust of pharmaceutical companies or the medical system as a whole, or have symptoms of depression that make taking healthy actions more difficult. In addition, patients may be unable to afford their medication, or their lack of symptoms may lead them to believe they don’t really need the prescription, as occurs with disorders such as hypertension or high cholesterol.
“In my training, we did something called Balint training, where we would get together as a group with attendings and discuss cases that were difficult from a biopsychosocial perspective and consider all the factors in the patient perspective, including family dynamics, social systems, and economic realities,” said Russell Blackwelder, MD, director of geriatric education and associate professor of family medicine at the Medical University of South Carolina, Charleston.
“That training was, for me, very helpful for opening up and being more empathetic and really examining the patient’s point of view and everything that impacts them.”
Dr. Lovins agreed that it’s crucial to establish a good rapport and build mutual trust.
“If you don’t know the patient, you have a harder time asking the right questions to get to the meat of why they’re not taking their medicine or what they’re not doing to help their health,” she said. “It takes a little bit of trust on both parts to get to that question that really gets to the heart of why they’re not doing what you’re asking them to do.”
How to encourage adherence
Although there may not be a one-size-fits-all approach for achieving general adherence or adherence to a medication regimen, some methods may increase success.
Kenneth Zweig, MD, an internist at Northern Virginia Family Practice Associates, Alexandria, said that convincing patients to make one small change that they can sustain can get the ball rolling.
“I had one patient who was very overweight and had high blood pressure, high cholesterol, back pain, insomnia, and depression, who was also drinking three to four beers a night,” Dr. Zweig said. “After a long discussion, I challenged him to stop all alcohol for 1 week. At the end of the week, he noticed that he slept better, lost some weight, had lower blood pressure, and had more energy. Once he saw the benefits of this one change, he was motivated to improve other aspects of his health as well. He improved his diet, started exercising, and lost over 50 pounds. He has persisted with these lifestyle changes ever since.”
A team-based approach may also increase treatment understanding and adherence. In one older study, patients who were assigned to team-based care, including care by pharmacists, were significantly more adherent to medication regimens. Patients were more comfortable asking questions and raising concerns when they felt their treatment plan was a collaboration between several providers and themselves.
Dr. Lovins said to always approach the patient with a positive. “Say, what can we do together to make this work? What are your questions about this medication? And try and focus on the positive things that you can change instead of leaving the patient with a negative feeling or that you’re angry with them or that you’re unhappy with their choices. Patients respond better when they are treated as part of the team.”
Fear of judgment can also be a barrier to honesty between patients and their doctors. Shame creates a reluctance to admit nonadherence. Dr. Lovins said in an interview that it’s the physician’s responsibility to create a blame-free space for patients to speak openly about their struggles with treatment and reasons for nonadherence.
When should you redirect care?
Ultimately, the goal is good care and treatment of disease. However, if you and your patient are at an impasse and progress is stalling or failing, it may be appropriate to encourage the patient to seek care elsewhere.
“Just like any relationship, some physician-patient relationships are just not a good fit,” said Dr. Blackwelder. And this may be the reason why the patient is nonadherent — something between the two of you doesn’t click.
While there are ethical considerations for this decision, most medical boards have guidelines on how to go about it, Dr. Blackwelder said in an interview. “In the state of South Carolina, we have to be available to provide urgent coverage for at least 30 days and notify the patient in writing that they need to find somebody else and to help them find somebody else if we can.”
Just as with care, a clear conversation is the best practice if you’re proposing a potential shift away from a physician-patient relationship. You might say: We’re not making the kind of progress I’d like to see, and I’m wondering if you think working with another doctor may help you.
“The most important thing is being very honest and transparent with the patient that you’re concerned you’re not making the appropriate strides forward,” said Dr. Rabinovitz. Then you can ask, ‘Am I the right doctor to help you reach your goals? And if not, how can I help you get to where you need to be?’ ”
A version of this article first appeared on Medscape.com.
The term “nonadherent” has gradually replaced “noncompliant” in the physician lexicon as a nod to the evolving doctor-patient relationship. Noncompliance implies that a patient isn’t following their doctor’s orders. Adherence, on the other hand, is a measure of how closely your patient’s behavior matches the recommendations you’ve made. It’s a subtle difference but an important distinction in approaching care.
“Noncompliance is inherently negative feedback to the patient, whereas there’s a reason for nonadherence, and it’s usually external,” said Sharon Rabinovitz, MD, president of the Georgia Academy of Family Physicians.
Why won’t patients listen?
The reasons behind a patient’s nonadherence are multifaceted, but they are often driven by social determinants of health, such as transportation, poor health literacy, finances, and lack of access to pharmacies.
Other times, patients don’t want to take medicine, don’t prioritize their health, or they find the dietary and lifestyle modifications doctors suggest too hard to make or they struggle at losing weight, eating more healthfully, or cutting back on alcohol, for instance.
“When you come down to it, the big hindrance of it all is cost and the ability for the patient to be able to afford some of the things that we think they should be able to do,” said Teresa Lovins, MD, a physician in private practice Columbus, Ind., and a member of the board of directors of the American Academy of Family Physicians.
Another common deterrent to treatment is undesired side effects that a patient may not want to mention.
“For example, a lot of patients who are taking antidepressants have sexual dysfunction associated with those medications,” said Dr. Rabinovitz. “If you don’t ask the right questions, you’re not going to be able to fully assess the experience the patient is having and a reason why they might not take it [the medication].”
Much nonadherence is intentional and is based on experience, belief systems, and knowledge. For example, the American Medical Association finds that patients may not understand why they need a certain treatment (and therefore dismiss it), or they may be overloaded with multiple medications, fear dependency on a drug, have a mistrust of pharmaceutical companies or the medical system as a whole, or have symptoms of depression that make taking healthy actions more difficult. In addition, patients may be unable to afford their medication, or their lack of symptoms may lead them to believe they don’t really need the prescription, as occurs with disorders such as hypertension or high cholesterol.
“In my training, we did something called Balint training, where we would get together as a group with attendings and discuss cases that were difficult from a biopsychosocial perspective and consider all the factors in the patient perspective, including family dynamics, social systems, and economic realities,” said Russell Blackwelder, MD, director of geriatric education and associate professor of family medicine at the Medical University of South Carolina, Charleston.
“That training was, for me, very helpful for opening up and being more empathetic and really examining the patient’s point of view and everything that impacts them.”
Dr. Lovins agreed that it’s crucial to establish a good rapport and build mutual trust.
“If you don’t know the patient, you have a harder time asking the right questions to get to the meat of why they’re not taking their medicine or what they’re not doing to help their health,” she said. “It takes a little bit of trust on both parts to get to that question that really gets to the heart of why they’re not doing what you’re asking them to do.”
How to encourage adherence
Although there may not be a one-size-fits-all approach for achieving general adherence or adherence to a medication regimen, some methods may increase success.
Kenneth Zweig, MD, an internist at Northern Virginia Family Practice Associates, Alexandria, said that convincing patients to make one small change that they can sustain can get the ball rolling.
“I had one patient who was very overweight and had high blood pressure, high cholesterol, back pain, insomnia, and depression, who was also drinking three to four beers a night,” Dr. Zweig said. “After a long discussion, I challenged him to stop all alcohol for 1 week. At the end of the week, he noticed that he slept better, lost some weight, had lower blood pressure, and had more energy. Once he saw the benefits of this one change, he was motivated to improve other aspects of his health as well. He improved his diet, started exercising, and lost over 50 pounds. He has persisted with these lifestyle changes ever since.”
A team-based approach may also increase treatment understanding and adherence. In one older study, patients who were assigned to team-based care, including care by pharmacists, were significantly more adherent to medication regimens. Patients were more comfortable asking questions and raising concerns when they felt their treatment plan was a collaboration between several providers and themselves.
Dr. Lovins said to always approach the patient with a positive. “Say, what can we do together to make this work? What are your questions about this medication? And try and focus on the positive things that you can change instead of leaving the patient with a negative feeling or that you’re angry with them or that you’re unhappy with their choices. Patients respond better when they are treated as part of the team.”
Fear of judgment can also be a barrier to honesty between patients and their doctors. Shame creates a reluctance to admit nonadherence. Dr. Lovins said in an interview that it’s the physician’s responsibility to create a blame-free space for patients to speak openly about their struggles with treatment and reasons for nonadherence.
When should you redirect care?
Ultimately, the goal is good care and treatment of disease. However, if you and your patient are at an impasse and progress is stalling or failing, it may be appropriate to encourage the patient to seek care elsewhere.
“Just like any relationship, some physician-patient relationships are just not a good fit,” said Dr. Blackwelder. And this may be the reason why the patient is nonadherent — something between the two of you doesn’t click.
While there are ethical considerations for this decision, most medical boards have guidelines on how to go about it, Dr. Blackwelder said in an interview. “In the state of South Carolina, we have to be available to provide urgent coverage for at least 30 days and notify the patient in writing that they need to find somebody else and to help them find somebody else if we can.”
Just as with care, a clear conversation is the best practice if you’re proposing a potential shift away from a physician-patient relationship. You might say: We’re not making the kind of progress I’d like to see, and I’m wondering if you think working with another doctor may help you.
“The most important thing is being very honest and transparent with the patient that you’re concerned you’re not making the appropriate strides forward,” said Dr. Rabinovitz. Then you can ask, ‘Am I the right doctor to help you reach your goals? And if not, how can I help you get to where you need to be?’ ”
A version of this article first appeared on Medscape.com.
The term “nonadherent” has gradually replaced “noncompliant” in the physician lexicon as a nod to the evolving doctor-patient relationship. Noncompliance implies that a patient isn’t following their doctor’s orders. Adherence, on the other hand, is a measure of how closely your patient’s behavior matches the recommendations you’ve made. It’s a subtle difference but an important distinction in approaching care.
“Noncompliance is inherently negative feedback to the patient, whereas there’s a reason for nonadherence, and it’s usually external,” said Sharon Rabinovitz, MD, president of the Georgia Academy of Family Physicians.
Why won’t patients listen?
The reasons behind a patient’s nonadherence are multifaceted, but they are often driven by social determinants of health, such as transportation, poor health literacy, finances, and lack of access to pharmacies.
Other times, patients don’t want to take medicine, don’t prioritize their health, or they find the dietary and lifestyle modifications doctors suggest too hard to make or they struggle at losing weight, eating more healthfully, or cutting back on alcohol, for instance.
“When you come down to it, the big hindrance of it all is cost and the ability for the patient to be able to afford some of the things that we think they should be able to do,” said Teresa Lovins, MD, a physician in private practice Columbus, Ind., and a member of the board of directors of the American Academy of Family Physicians.
Another common deterrent to treatment is undesired side effects that a patient may not want to mention.
“For example, a lot of patients who are taking antidepressants have sexual dysfunction associated with those medications,” said Dr. Rabinovitz. “If you don’t ask the right questions, you’re not going to be able to fully assess the experience the patient is having and a reason why they might not take it [the medication].”
Much nonadherence is intentional and is based on experience, belief systems, and knowledge. For example, the American Medical Association finds that patients may not understand why they need a certain treatment (and therefore dismiss it), or they may be overloaded with multiple medications, fear dependency on a drug, have a mistrust of pharmaceutical companies or the medical system as a whole, or have symptoms of depression that make taking healthy actions more difficult. In addition, patients may be unable to afford their medication, or their lack of symptoms may lead them to believe they don’t really need the prescription, as occurs with disorders such as hypertension or high cholesterol.
“In my training, we did something called Balint training, where we would get together as a group with attendings and discuss cases that were difficult from a biopsychosocial perspective and consider all the factors in the patient perspective, including family dynamics, social systems, and economic realities,” said Russell Blackwelder, MD, director of geriatric education and associate professor of family medicine at the Medical University of South Carolina, Charleston.
“That training was, for me, very helpful for opening up and being more empathetic and really examining the patient’s point of view and everything that impacts them.”
Dr. Lovins agreed that it’s crucial to establish a good rapport and build mutual trust.
“If you don’t know the patient, you have a harder time asking the right questions to get to the meat of why they’re not taking their medicine or what they’re not doing to help their health,” she said. “It takes a little bit of trust on both parts to get to that question that really gets to the heart of why they’re not doing what you’re asking them to do.”
How to encourage adherence
Although there may not be a one-size-fits-all approach for achieving general adherence or adherence to a medication regimen, some methods may increase success.
Kenneth Zweig, MD, an internist at Northern Virginia Family Practice Associates, Alexandria, said that convincing patients to make one small change that they can sustain can get the ball rolling.
“I had one patient who was very overweight and had high blood pressure, high cholesterol, back pain, insomnia, and depression, who was also drinking three to four beers a night,” Dr. Zweig said. “After a long discussion, I challenged him to stop all alcohol for 1 week. At the end of the week, he noticed that he slept better, lost some weight, had lower blood pressure, and had more energy. Once he saw the benefits of this one change, he was motivated to improve other aspects of his health as well. He improved his diet, started exercising, and lost over 50 pounds. He has persisted with these lifestyle changes ever since.”
A team-based approach may also increase treatment understanding and adherence. In one older study, patients who were assigned to team-based care, including care by pharmacists, were significantly more adherent to medication regimens. Patients were more comfortable asking questions and raising concerns when they felt their treatment plan was a collaboration between several providers and themselves.
Dr. Lovins said to always approach the patient with a positive. “Say, what can we do together to make this work? What are your questions about this medication? And try and focus on the positive things that you can change instead of leaving the patient with a negative feeling or that you’re angry with them or that you’re unhappy with their choices. Patients respond better when they are treated as part of the team.”
Fear of judgment can also be a barrier to honesty between patients and their doctors. Shame creates a reluctance to admit nonadherence. Dr. Lovins said in an interview that it’s the physician’s responsibility to create a blame-free space for patients to speak openly about their struggles with treatment and reasons for nonadherence.
When should you redirect care?
Ultimately, the goal is good care and treatment of disease. However, if you and your patient are at an impasse and progress is stalling or failing, it may be appropriate to encourage the patient to seek care elsewhere.
“Just like any relationship, some physician-patient relationships are just not a good fit,” said Dr. Blackwelder. And this may be the reason why the patient is nonadherent — something between the two of you doesn’t click.
While there are ethical considerations for this decision, most medical boards have guidelines on how to go about it, Dr. Blackwelder said in an interview. “In the state of South Carolina, we have to be available to provide urgent coverage for at least 30 days and notify the patient in writing that they need to find somebody else and to help them find somebody else if we can.”
Just as with care, a clear conversation is the best practice if you’re proposing a potential shift away from a physician-patient relationship. You might say: We’re not making the kind of progress I’d like to see, and I’m wondering if you think working with another doctor may help you.
“The most important thing is being very honest and transparent with the patient that you’re concerned you’re not making the appropriate strides forward,” said Dr. Rabinovitz. Then you can ask, ‘Am I the right doctor to help you reach your goals? And if not, how can I help you get to where you need to be?’ ”
A version of this article first appeared on Medscape.com.