Physician Well Being: Then and Now

Seventy years ago, Life magazine published a photograph essay depicting two weeks in the life of Dr. Ernest Ceriani, a general practitioner in Colorado. The images of his 1948 rural practice are riveting. He delivers babies, performs trauma surgery, practices geriatrics, and makes house calls. You wonder how he stayed continuously accessible without a beeper or a cell phone. It also seems unlikely he either carried or needed malpractice insurance, and he certainly didn’t record anything in an EHR. He appears exhausted, but content. Remarkable as he was, it’s interesting to consider that there were thousands of rural doctors just like him who were on call 24/7 for a lifetime, but no reports of widespread physician burnout from the era.

This week’s issue of JAMA includes a viewpoint by Thomas Schwenk on “Physician Well-being and the Regenerative Power of Caring.”

There is also a “Charter on Physician Well-Being,” the impetus for which is an epidemic of physician dissatisfaction, burnout, depression, and even suicide which contributes to sub-optimal patient care, lower patient satisfaction, decreased access to care and an increase in the cost of healthcare. If you stop any doctor and ask them what ONE thing, if changed, would most improve their enjoyment of practicing medicine, the answer would probably be the time wasted entering data into unfriendly EHRs to record “quality data” irrelevant to their practice. They might also cite frustration with the endless hamster wheel of productivity-based compensation at a time when payment rates are plummeting. The simple math, “see more patients in less time,” prevents caring relationships of the type Dr. Ceriani knew from ever forming between doctor and patient.

The JAMA article recommends several ways to improve physician well-being, such as making healthy food choices available in the doctor’s dining room, improving work schedules, and incentivizing participation in lifestyle initiatives. However, when you look at the sepia toned photographs of Dr. Ceriani, it is pretty clear that he had no healthy life habits and never heard the term “work life balance.” What he did have was a personal, caring relationship with each of his patients, who in turn must have deeply cared about and valued him.

Today’s doctors may be no less dedicated, but we are certainly less connected to our patients emotionally. That’s one reason I love wound care. A frail couple in matching scooters, married 70 years, told me that the secret to a successful marriage was a spirit of forgiveness. Yesterday the husband of a longtime patient brought their wedding photos. She’s now partially paralyzed and it was important to him that we know how beautiful she had been. Then he turned and looked at her and said, “She is STILL beautiful.”

The Schwenk  article also suggests that “highly functional interdisciplinary teams” can contribute to physician well-being. I can’t agree more about that. I love my staff so much. They cheerfully help each other with challenging patients, they have incredible clinical judgement on which I rely, and they work hard to keep me from dropping the ball on a myriad of little details. A team like that is crucial to everyone’s well-being. Thank you guys! I appreciate you!

After I read these articles in JAMA, I realize that one of the things that makes wound care so satisfying is the time we have with patients. Wounds heal slowly and our treatments can’t be completed in 10 minutes. During those visits, patients have told me epic love stories in weekly installments, and movie- worthy war stories. After I finished a consultation with one terribly frail old man, his body withered, his son said to me, “He was at Iwo Jima.” We laugh and we cry as a team. So, if you are a wound care practitioner, listen to a patient’s story today, tell your team you appreciate them, and eat something organic in the doctor’s dining room.