Nudges And Burnout


Leonard Zwelling

It is increasingly difficult for me to understand the subtleties of the articles in the two journals I continue to read—The New England Journal of Medicine and Science. This is my shortcoming not that of the editors or authors. I simply have not kept up with modern methodology and often I am incapable of evaluating the quality of the data of the papers I try to decipher. I read the Abstracts and move on.

This is not the case with the editorials. These I can still understand and there were a few in the NEJM in the past week worthy of comment.

In the January 18 issue, there was one by Patel et al. about nudges. They are essentially clues in the performance of clinical medicine that will get the doctor to the right action and conclusion more than not. I was impressed that much of this had to do with the electronic medical record and how it lists choices in drop-down menus to make work more efficient. I was impressed that academics were actually concerned enough to study the way in which physicians work, to make that work easier. This seems like an excellent idea to me and “Nudge Units” (groups that study this) that improve the way physicians can work might be the next big thing in large hospitals and clinic systems to improve the quality of care by making it easier to do the right thing.

The next issue of the NEJM had two editorials about physician burn-out—how to recognize it and how to prevent it. This is in the January 25.

Two groups write about this problem and how it is becoming more prevalent and, like nudges, how it is being studied. Again, the solution to this problem had to do with careful examination of exactly how care is delivered, asking doctors what is working and what is not, and designing systems to allow doctors to do more doctor work and less secretarial work, as is becoming the norm. In fact, this is getting worse as the ability to do chart work migrates from the clinic to the home computer, doctors are getting home for dinner and then working three more hours. That’s an extra week a month of work. How is that a good idea?

The use of computers makes record accrual more efficient, but does not necessarily make patient care better nor remove barriers that separate doctors from their patients. It may make the latter worse. I have been questioned over a laptop by a physician. It sucks.

Let’s hope the fact that academia has turned its attention to measuring how doctors interact with patients, how they make decisions, and what the consequences of both are on the doctors and the patients is a new trend. That would be a very good first step to increasing the length of careers in medicine and improving doctor and patient satisfaction.

Leonard Zwelling