Commentary

Restoring joy in the exam room: A DO’s secret

While in residency, I’ve made a small change that has reduced my feelings of burnout and made clinic very tolerable and—dare I say it—happy for me.

Editor’s note: This article first appeared on KevinMD. It has been edited for The DO and re-posted with permission. This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

As someone who has been in the medical field for nearly 10 years, I have had the opportunity to follow many physicians. I started off shadowing physicians, standing behind them as they would speak to patients in their rooms.

Now, as a resident physician, I spend hours and hours each week in the clinic seeing my own patients. Every week, I read about burnout and how it impacts my fellow physicians. Every week, there are depressing posts about life and grumbles about physicians retiring due to EMR nonsense.

Omar Bukhari, DO

Recent surveys suggest that a third to a half of each physician’s time is dedicated to bureaucratic tasks like EMR charting. As an optimistic, academic physician, I decided to take my psyche into my own hands and do something slightly different.

This action is something that few other physicians do from what I have seen, but it is something that has lessened my feelings of burnout, and something that has made clinic very tolerable and—dare I say it—happy for me.

Small change, big difference

The action is that I don’t bring my laptop in with me to the exam room. The difference is startling in how much more effective I am in dealing with the issues that my patients have. Suddenly, the emotions that patients are giving to me become real. I can’t ignore the anguish on the depressed person’s face or the happiness on another patient’s face after I have helped her lose 40 pounds.

It helps me to connect with my patients and, more importantly, it helps me to remember who I am helping. Even though it adds time to my day to dictate into the EMR after each patient visit, I feel less burned out at the end of a clinic day. This is because I have spent the whole day giving my full, undivided attention to my patients. They are grateful in return, listening to what I have to say because they feel listened to.

‘Didn’t look up once’

I remember shadowing a physician who was seeing an elderly woman in the clinic. The physician didn’t look up once from the computer, instead frantically going through the chart looking at medications, labs, health maintenance reminders, billing reminders, telephone encounters, scans, and orders.

The physician did not see her face once while she told him a long, drawn-out story about her past. Even though the story had nothing to do with her health, it was at that moment that I noticed how disconnected our assembly-line medical practices have become.

In the eyes of the EMR, the doctor was an effective biller and a great cog in the system. But in my eyes, he wasn’t the type of doctor that I would want for myself. The personal touch is what makes medicine great, and losing that to the computer is often what burns physicians out.

So I ask those out there reading this: Let us return to seeing our patients, not seeing the EMR.

Related reading

5 facets of physician burnout

Doctor burnout: Two brand-new JAMA studies raise more concerns

11 comments

  1. Soooo true. Don’t know how many written comments I have received from patients stating that I actually “listened” to them. I’m in Urgent Care and we have a great, simple EMR, so that makes it easier, but I wholely agree…look them in the eye and show compassion and the love of Christ, and it makes all the difference in the world! Thanks for sharing this story!!

  2. I have been there( in practice for 25 yrs and gone thru the change in how we practice) and totally agree that not having the computer in the room is better! I am able to connect and feel less stressed! Technology is good but we have to keep a balance! Well said!

  3. Really?? Burn out in today residencies? With mandated limits on hours worked? If your already “burnt out” i would recommend a change in professions. Good luck, and yes i am a DO

    1. Sir: unproductive, dismissive, archaic responses like that, are of little value. That attitude perpetuates the destructive culture of masochism, where exhaustion is a status symbol and productivity is the measure of self-worth. When residents commit suicide, are you “glad to see the weaklings culled?”

      Simplified, there are two possible responses to the question of suffering during training:
      1) “during my training I suffered terribly, therefore everyone else should too!”
      2) “during my training I suffered terribly, and nobody else should have to endure that.”

      Why choose the former? I hope you’re not training residents! Our training model is a hundred years old, from when William Halstead’s surgical residents couldn’t keep up with his work pace because of all the cocaine he was using. Is it possible to consider that there could be better ways to train docs?

      Physician culture has failed its physicians. Through social media we are finally able to break free from our self-imposed silos of private suffering, and turn to each other for compassion and support.

      I am sorry that you suffered, and were never offered compassion. That journey must have been incredibly difficult.

  4. As a recent residency grad and newly practicing pediatrician I’ve incorporated this into my practice as well. The best, busiest, and most efficient attendings I had in residency did not chart in the patient room and neither do I now in practice. Let’s keep it up!

  5. I try and keep a small electronic footprint so as to mitigate the “elephant” in the room, as I keep a small notebook that is below eye level with my patient’s and always LOOK them in the eyes, and obviously disengage from the laptop entirely during the physical exam. Interestingly, I find a lot of the pearls I learn from my patient’s histories are often during the exam when it is just the two of us with no computer separating the bond.

  6. The purpose of bringing your laptop is not to do notes, but to have information at hand to share with your patient, labs, imaging etc.
    An excellent physician should be able to function with technology at hand along with providing personal care.

  7. As a recent FM grad and currently practicing in a major city; it is hard to agree with your opinion. We have laptops/ipads in our hands to show patient their results (lab work, images,scanned material.) There’s always an option of placing your tech device on the side in the room. Yes we have to pay attention to our patients; but if you struggle to multi-task at times; then maybe consider having a smaller number of patients in your future practice.

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