Common Sense

Letters to the Editor

Emergency Medicine Wellness Bill Of Rights

I loved Dr. Mayer’s article in May/June 2019 of Common Sense, “Emergency Medicine Wellness Bill Of Rights.” What could be better to bring to our loving democratic culture than an emergency physician bill of rights? 

Somewhere along the near universal incorporation of EMRs into medicine, physician wellness seems to have tapered off. "Burnout by a thousand clicks," one study noting physicians spend more time on the EMR (40 percent),1,2,3 than performing direct patient care (30 percent). Have you ever received "the look" from a patient in discomfort or distress while you vigorously document? Meanwhile it's difficult for the patient to comprehend why the physician is surfing the web instead of delivering care. To compound our wellness woes, nearly half (47 percent) of emergency physicians report having been physically assaulted while at work.

We as physicians should be entitled to a safe and respectful workplace. Somewhere in the course of residency training we accept that becoming an emergency physician means enduring no bathroom breaks, scarfing down food while hiding from administrators and patients in the crannies of the ED, and becoming a stoic wall to verbal threats as well as occasional physical violence.

While I don't think a physician bill of rights will cure all these problems, it is certainly a good start. Here are some items I’d propose:

  • Ability to eat and drink in non-patient care areas in the workplace (without fear of the most recent Joint Commission, State, EMS, etc. audit of the department)
  • A mandatory 10-15 minute break where you are required to leave the department to eat/pee/breathe
  • Verbally abusive patients are subject to a medical screening examination and then in some fashion can be fired as a patient (they can return to the waiting room to wait for the next provider or they can leave)
  • Mandatory scribe implementation; the EMR is here to stay, and until we reform healthcare to what truly matters, patient care and the unfettered ability to actually interact with patient, a strong assist is needed to be able to schedule additional time and remove the focus from itemized billing, most recent CMS measures (yes sepsis, I'm looking at you), RVUs, and of course data entry.

A safe workspace that values and protects its physicians is of utmost importance. The better we are able to care for ourselves, the better we will be able to care for our patients. Implementing a physician bill of rights might just be the start we need.

References

  1. Hill RG Jr, Sears LM, Melanson SW. 4000 clicks: a productivity analysis of electronic medical records in a community hospital ED. Am J Emerg Med. 2013;31(11):1591-1594.
  2. Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clinic Proc. 2016;91(7):836-848.
  3. Salyers MP, Bonfils KA, Luther L, et al. The relationship between professional burnout and quality and safety in healthcare: a meta-analysis. J Gen Intern Med. 2017;32(4):475-482.
  4. https://www.newyorker.com/culture/annals-of-inquiry/why-doctors-should-organize, accessed August 2, 2019. 
  5. http://newsroom.acep.org/2018-10-02-Violence-in-Emergency-Departments-Is-Increasing-Harming-Patients-New-Research-Finds, accessed August 2, 2019.

-Brad Schwartz, MD
Cheverly, Maryland

-Breanna Kebort, MD
Baltimore, Maryland


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