Dr Mandrola: Finally, we hear a lot from the Medscape audience and our survey shows that physicians are burned out. What would you say to them?
Dr Verghese: There are good data that 50% of primary care physicians are burned out. More than 50% are depressed, which makes you realize at once that it's not an individual problem. It's a systemic issue. The root of it is red tape. Our red tape equivalent is the EMR. I think organizations like the ACC should come out and say that the source of dysfunction and dysphoria among physicians, the source of frustration in the system, is that we are busy documenting something that has nothing to do with patient care. I'm not pessimistic about it; I'm a great optimist. I think that things will get better, but I think that you can't make it better until you acknowledge the problem. It's like a Dickens novel. There's a point, an epiphany, where the big lie is revealed to the person who is carrying it. Then everything sorts itself out.
Dr Mandrola: Being distracted from what we were supposed to do is terrible for physicians. I think the employment model has made it worse because we get put on the assembly line. I hope it does change.
Dr Verghese: There are some good models of successful practices; Christine Sinsky at the ABIM Foundation has looked at practices that have been extraordinarily successful. One of the common features is to make the physician experience much less about the red tape and much more about the patient. For example, calling the patient the day before and establishing the agenda for the visit so that they don't come in with 16 things when you think it's a follow-up for one thing; calling the patient ahead of time and reconciling medications before they arrive; or drawing labs and having the results there on the same day, rather than having them come back—these are all such simple efficiencies.
Another practice had the physician, the social worker, and the physical therapist all in one common area. Instead of sending an email to somebody, you just turned around and spoke to them. You get things done much more efficiently. Having a scribe—having someone else to do the paperwork—is a really good way to make people happy about what they're doing. They are more efficient.