A week ago today, the National Academy of Medicine held its third public meeting of the Action Collaborative on Clinician Well-Being and Resilience in Washington, D.C. According to the National Academy of Medicine: “Clinician well-being is essential for safe, high-quality patient care. However, clinicians of all kinds, across all specialties and care settings, are experiencing alarming rates of burnout.
“Among the most telling of statistics, more than 50 percent of U.S. physicians report significant symptoms. Burnout is a syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.”
In 2008, the Institute of Healthcare Improvement introduced the concept of the “triple aim”: “Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of the populations and reducing per capita costs of health care. “
Most health plans have pursued this triple aim. They have implemented policies and programs that direct and influence physician behavior. Your primary care physician receives these directives, then interacts with you. Your physicians are measured and pressured to be attentive to the needs and desires of individual patients, to complete the designated “quality metrics” for their panel of patients and to reduce total health care expenditures.
Primary care physicians are motivated by the “joy” of caring for their patients. Unfortunately, implementation of the triple-aim objectives often means that your physician needs to allocate more time to complete administrative tasks. These tasks often end up distracting your physician from spending more time with you, the patient. This distraction has left many of our physicians in a state of frustration, anxiety, dissatisfaction, unhappiness and worry about their future, i.e., burnout.
The “quadruple aim” was introduced in 2014 in the Annals of Family Medicine: “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.” The authors wrote: “The positive engagement, rather than the negative frustration, of the health care workforce is of paramount importance in achieving the primary goal of the Triple Aim-improving population health.”
Your physician has spent years in school, training and ongoing education. He or she has made a commitment to care for you, to be available to you, to listen to you, to stick with you, to help you address and manage your physical and emotional health needs. Your physician, by focusing on your health, intends to create and foster a personal professional relationship with you.
Can we protect our physicians’ well-being and prevent burnout? Patients should ask their physicians: “How are you feeling? If you are feeling stress, why? How long will you be my doctor?” Patients should ask their health plan: “Do you believe in the quadruple aim? Do you have resources and programs to inspire my physicians to give me their undivided attention and their best effort in thoughtful and empathetic advice about my health?“
Care of the health-care provider translates into better care of the patient. We, at the American Academy of Pediatrics, Hawaii Chapter, are committed to the quadruple aim. We have joined the National Academy of Medicine’s action collaborative on clinician well-being and resilience and have initiated an active program to foster physician well-being, resilience and guard against physician burnout. Who else will take action?
Your health, the health of your physicians, the health of our community begs for a commitment to the quadruple aim.
Galen Chock, M.D., is chairman of Ka Huliau, Medical Home Task Force, American Academy of Pediatrics, Hawaii Chapter.
