Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes

Erin E. Sullivan; Maram Khazen; Sophia D. Arabadjis; Maria Mirica; Jason M. Ramos; Andrew P.J. Olson; Mark Linzer; Gordon D. Schiff

doi:10.1515/dx-2022-0118

Article

Exploring relationships between physician stress, burnout, and diagnostic elements in clinician notes

Erin E. Sullivan , Maram Khazen , Sophia D. Arabadjis , Maria Mirica , Jason M. Ramos , Andrew P.J. Olson , Mark Linzer and Gordon D. Schiff

Published/Copyright: March 7, 2023

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From the journal Diagnosis Volume 10 Issue 3

Abstract

Objectives

To understand the relationship between stressful work environments and patient care by assessing work conditions, burnout, and elements of the diagnostic process.

Methods

Notes and transcripts of audiotaped encounters were assessed for verbal and written documentation related to psychosocial data, differential diagnosis, acknowledgement of uncertainty, and other diagnosis-relevant contextual elements using 5-point Likert scales in seven primary care physicians (PCPs) and 28 patients in urgent care settings. Encounter time spent vs time needed (time pressure) was collected from time stamps and clinician surveys. Study physicians completed surveys on stress, burnout, and work conditions using the Mini-Z survey.

Results

Physicians with high stress or burnout were less likely to record psychosocial information in transcripts and notes (psychosocial information noted in 0% of encounters in 4 high stress/burned-out physicians), whereas low stress physicians (n=3) recorded psychosocial information consistently in 67% of encounters. Burned-out physicians discussed a differential diagnosis in only 31% of encounters (low counts concentrated in two physicians) vs. in 73% of non-burned-out doctors’ encounters. Burned-out and non-burned-out doctors spent comparable amounts of time with patients (about 25 min).

Conclusions

Key diagnostic elements were seen less often in encounter transcripts and notes in burned-out urgent care physicians.

Keywords: diagnosis; physician stress; work conditions

Corresponding author: Erin E. Sullivan, PhD, Sawyer School of Business, Suffolk University, Sargent Hall Room 5623, 110 Tremont Street, Boston, MA 02108, USA; and Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA, E-mail: esullivan5@suffolk.edu

Funding source: CRICO Malpractice Insurance

Research funding: This work was supported by CRICO Malpractice Insurance in Boston, MA. The funder did not have a role in study design; the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Author contribution: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Dr. Linzer was paid as a consultant on this project (funds donated to Hennepin Healthcare Foundation), and is supported through his place of employment (Hennepin Healthcare) by the American Medical Association, American College of Physicians, the Optum Office for Provider Advancement (OPA), Essentia Health Systems, Gillette Children’s Hospital, the Institute for Healthcare Improvement, and the American Board of Internal Medicine Foundation for burnout prevention research and training, and by AHRQ as a leader of a K12 training program for Learning Health System scholars.
Informed consent: Informed consent was obtained from all individuals included in this study. More specifically: Research staff approached patients of enrolled physicians in the clinic waiting room, introduced them to the study and provided written information explaining that the encounter would be recorded and reviewed. Patients were given sufficient time to read the written information and refer to the research staff for questions. To minimize interruptions to the workflow, PCPs asked for a verbal consent from patients who agreed to participate, once they were in the room. The verbal consent was recorded as part of the encounter, as approved by the ethics committee.
Ethical approval: This project received approval from the Institutional Review Board at Mass General Brigham.

References

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Received: 2022-10-24

Accepted: 2023-02-13

Published Online: 2023-03-07

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Articles in the same Issue

https://doi.org/10.1515/dx-2022-0118

Keywords for this article

diagnosis; physician stress; work conditions