We physicians could have told you that!

Yesterday I spotted a study in the Annals of Internal Medicine7 July 2009 | Volume 151 Issue 1, titled "Working Conditions in Primary Care: Physician Reactions and Care Quality".

Guess what they discovered??

More than one half of the physicians (53.1%) reported time pressure during office visits, 48.1% said their work pace was chaotic, 78.4% noted low control over their work, and 26.5% reported burnout.

Adverse workflow (time pressure and chaotic environments), low work control, and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave.

Some work conditions were associated with lower quality and more errors, but findings were inconsistent across work conditions and diagnoses.

No association was found between adverse physician reactions, such as stress and burnout, and care quality or errors.

In case you're a reader who is not familiar with the definition of "burnout", here is one version:

Burnout is a debilitating psychological condition brought about by unrelieved work stress, resulting in:

• Depleted energy and emotional exhaustion
• Lowered resistance to illness
• Increased depersonalization in interpersonal relationships
• Increased dissatisfaction and pessimism

This means that one in four primary care physicians has arrived at this advanced condition of psychological distress. And I bet it isn't all that different in the specialties.

We physicians have been trying to tell this to anyone who will listen.

Is this really who you want caring for you and your family (and ultimately us)?

Would we let this happen to our pilots?

It is also interesting in the study that "no consistent associations were found between adverse work conditions and the quality of patient care, and no associations were seen between adverse physician reactions and the quality of patient care".

I take this to mean that, despite how rotten so many doctors feel, they still perform at acceptable levels.

In case you find this comforting, I'd like to point out that this observation may hide two dangers:

1. Physicians may kid themselves that they can keep doing it because no-one is getting hurt, and they may feel the need to "keep pushing through the psychic pain" (the macho approach)

2. This may provide society with an excuse to not have to examine the working conditions of the physician work force and recommend or support any changes. Latent envy of "physicians driving Porsches" may surface instead (I commonly see these anti-physician hostile stereotype comments on blogs).

I believe we ALL lose out in the end.

What's your reaction?