“You do not rise to the level of your goals. You fall to the level of your systems.” – James Clear, Atomic Habits I had a bit of a revelation recently when I brought my dog in for grooming. Some background: My dog is ten years old and has a double coat from hell (although very pretty). She also had a spinal cord injury in November 2019 and has residual weakness in her back legs, so she has trouble standing for long periods. Also, she won’t let me brush her. At all. Despite her back legs’ weakness, she runs if she sees me with a brush. It’s too sad for me. You can see who’s in charge here. Recently I brought her in for grooming at PetSmart, and the person checking her in was concerned for a moment about her appointment length. “Oh, that’s right,” she said, “I remembered that she needs some extra time, and I booked her appointment for longer over on this other schedule.” That’s right. The PetSmart groomers have the ability to book longer appointments for clients that they know need it. I don’t know what the requirements are to work as a groomer in PetSmart, but having a graduate-level degree is probably not on the list. And yet, so many physicians that I know do not have the option of scheduling longer appointments for patients who need it. Either they’re employed and their clinic time slots are mandated by someone else, or they’re in private practice, where overhead pressure may cause them to see more patients in less time. This means if they have a patient who needs more time, they either run late or don’t address all the patient’s needs. Or both. Often physicians don’t feel like they have the freedom to schedule longer appointment times for the patients who need it. Yet, the amount of items they are supposed to address during those appointments seems to increase every year, along with financial pressures. Since lack of autonomy is one of the main factors leading to burnout, improving autonomy could decrease the high levels of burnout today. Too many programs to fix burnout focus on stress reduction that the individual is responsible for implementing, not on fixing the systemic problems in the current practice of medicine. If we want to improve burnout, we need to focus on systemic issues. Full stop. We cannot just tell individual doctors or departments that they need to manage their stress better. We need to evaluate and revamp the systemic issues that lead to their collective stress. Individual doctors can’t fix the EMR. They can develop workarounds, but they shouldn’t have to. We can change the requirements of their employers, the insurers, the government. Systemic problems need systemic solutions, not everyone having their own individual fixes or workarounds. Source
