I hear a lot about physician burnout and the lure of non-clinical jobs beckoning to those doctors in the trenches who labor mightily under an increasing burden of patient care. However, I am not sure it is clear to those outside the medical profession that the patients are not the cause of the burden — it is the repetitive and inane tasks we are required to perform, most often to meet some type of regulation. These requirements range from the mildly annoying to profoundly ridiculous.
For example, I just went through my electronic in-basket. Among the messages were the following requests:
• Please order salt water gargles three times each day because of mouth soreness.
I get requests like this repeatedly from assisted living and long-term care facilities, because they are required to have a doctor's order for absolutely everything. I am just waiting for the requests to authorize the patient to have two teaspoons of sugar in his coffee instead of one, or the order that she may not wear her fuzzy slippers on linoleum flooring.
• Please certify in the medical record that the patient needs a walker (along with the specific details that must be documented).
This patient just had a leg amputated. It seems patently obvious that a patient missing a lower extremity would need some type of assistive device. Is it really necessary that I document in detail that he requires assistance walking and is at risk for falls? Apparently so.
I also bristle at requests to annually certify that a patient continues to suffer from a congenital medical disorder for which there is no cure or treatment. Is this really what Medicare needs to be concerned about?
I've had two patients recently make the transition from home to hospital to rehab facility to assisted living. At each transfer, I needed to sign several pages of the exact same orders — all with a different heading on top. Again, why? Could a single order set not be used across facilities, particularly when there's been no change in the medical condition and transfers are occurring within a short interval?
The list goes on and on. A 3 a.m. phone call to notify me that a patient at the nursing home died because they are required to notify a physician. A request for a referral to be ordered after the specialty appointment has already occurred. Having to order physical therapy to stop. Having to order occupational therapy to stop. Writing a prescription for an over-the-counter medication so that a government regulation can be met and allow my patient to use their own money to purchase the medication. ICD-10 requirements that mandate I need to enter the diagnosis of coronary artery disease twice — once to indicate the bypass surgery with a venous graft and the second to document the arterial graft.
The endless nonsensical requests need to stop. It has progressed from an annoyance to a distraction and will soon become the reason physicians continue to leave clinical practice in search of saner jobs — like working for an insurance company.