This issue of Physician Outlook magazine has literally taken me several months to produce and get to the printer, and it is with a sense of relief and profound gratitude that I am finally able to put these words on paper. I recently had an epiphany during a session with my physician coach, Dr. Deb Roman. We were chatting about my life-long tendency to try to multitask, and reflecting on how this strategy was no longer serving me when the lightbulb went off and I experienced my “a-ha moment.”

For many years, I have resisted using the word “burnout” to describe my personal relationship with the career that I once adored and had always given me a sense of great fulfillment. For the first time in my adult life, I find myself living for the “day off,” craving time that is completely free from any and all patient care responsibilities.

I’ve been doctoring for more than three decades, and this is not how I ever expected to feel. I have ALWAYS been my happiest when I am one-on-one with a patient or a parent who needs my services. What, then, has changed?

ELECTRONIC HEALTH RECORDS.

Simply put, EHRs have broken me. Electronic Health Records, particularly Epic Health Systems (known as “the Cadillac” of all EHRs), innately promote and encourage their end users to dangerously multitask.

M u l t i – t a s k i n g leads to decreased productivity and can contribute to or cause medical errors. When we are making eye contact with the keyboard and not our patient, we are missing important cues and information that could be relevant to a differential diagnosis. If we DON’T bring our computer/laptop into the exam room, we often take our work home with us at the end of the long workday or finish our work on weekends. There is no beginning or end to our day. We lack boundaries. We start identifying with the time loop that plagues the Bill Murray character in the infamous 1993 “Groundhog Day” movie as he monotonously experiences the same day over and over again.

The decreased focus, cognitive overload,
and unreimbursed time spent outside of regular work hours
on administrative tasks is contributing to increasedstress levels
and leading to physician burnout.

As a profession, physicians are reporting rising levels of job dissatisfaction and feelings of detachment from our work and our patients. Many doctors are looking for a way out of clinical medicine, and many (tragically) are committing or contemplating suicide.

Epic’s Hyperspace, with its many screens, alerts, ever-elusive “refresh” buttons, Problem Lists, Diagnoses Tabs, and “Tips of the Day,” causes me to experience an extreme form of sensory overload. I sometimes talk (yell) in frustration at my computer screen, and I am often annoyed that the EHR isn’t “smart” enough to produce the test result or report I am searching for.

If the technology exists for Facebook, Instagram, and Twitter to fill our personal social media feeds with eerily accurate targeted advertising, why hasn’t someone in the medical space taken the time to invent similar automations for Electronic Health Records? Why do we have to constantly confuse patients with After Visit Summaries that erroneously list medications as “discontinued” instead of fixing the glitchy Outside Medication Reconciliation process? Why isn’t the Newborn Metabolic Screen a hard-coded Epic-wide “Care Gap” for all children?

EASTER EGG HUNTING

As a pediatrician with years of experience as a locum, I have had the “privilege” of working in many different hospitals and health systems, each with its own electronic medical records.

Epic is set up differently IN. EVERY. SINGLE. FACILITY, even at hospitals that are owned and operated by the same mega-health systems. In some EHRs, it can literally take HOURS to find basic information that is relevant and necessary for safe and effective patient care. I call it “Easter Egg hunting.” All of the information is somewhere in the EHR; it’s just not in the same place twice. There is a steep learning curve with Epic’s software, and an absurd fascination with end-users being able to customize. Personally, I don’t want to re-invent the wheel or play in Epic’s “Playground.” I want meaningful interactions with my patients during the workday and quality time with my family at home.

MULTI-TASKING IS A MYTH.

I am a life-long habitual serial multi-tasker in recovery.

I was raised thinking that I could do multiple things at once, and, more importantly, convinced that I could do them all well. I am smart, ambitious, passionate, engaging, and (once upon a time), I was efficient, task-oriented, and organized. I knew how to delegate those tasks that could be assigned to others, and I was able to effectively lead and motivate others to work as part of a team. I could do everything a man could do, AND I also became a mother, the quintessential ultimate multitasker of all time.

The term “multi-task” was first coined in the 1940s, but became popularized in 1960 by J.C.R. “Lick” Licklider, a brilliant mathematician, physicist, and psychologist who is commonly credited as being “the father of the internet.” Three years before I was born, Lick published his revolutionary paper entitled “Man Computer Symbiosis,” in which he foretold the eventual invention of real-time interactive computing. Licklider envisioned a future in which humans and computers would work together to solve complex problems.

In healthcare, the ideal symbiotic relationship would use “smart” Artificial Intelligence to scour and summarize a patient’s personal medical story, relevant family history, pertinent labs, specialist recommendations, and other useful information. It would synthesize this information and present the end-user (the patient’s physician) with a succinct summary of the pertinent
positives and negatives.

Licklider was a visionary ahead of his time, and it would behoove all Hospital Administrators and Chief Informatics Officers to revisit his groundbreaking tome, which argued that “Computers should be designed to work in a way that is intuitive and natural for humans, rather than forcing humans to adapt to the limitations of technology.”

(As for me, I will continue to work on the steps towards recovery from my errant multi-tasking ways. I need to accept the things I cannot change, find the courage to change the things I can, and pray for the wisdom to know the difference.)