Worrisome findings about the work load of doctors who work fulltime in hospitals comes from a recent survey of hospitalists published in JAMA Internal Medicine.
Hospitalists are physicians who treat patients only while they are in the hospital. As their plight was described by MedPageToday.com, many hospital physicians feel overburdened to the extent that it negatively affects patient care, satisfaction and maybe even safety.
In the JAMA survey, nearly 1 in 4 respondents said that their excess workload prevented them from fully exploring and discussing treatment options for some patients, and from fully answering their questions. More than 1 in 5 said they had delayed admitting or discharging patients until a subsequent shift.
Four in 10 of more than 500 hospitalists surveyed said their heavy workload was unsafe for patients at least once a month; nearly that many said that it was unsafe at least weekly.
So, what’s “unsafe” about having more work to do than you think is reasonable?
More than 1 in 5 doctors reported ordering potentially unnecessary tests or procedures because they did not have the time to exam a patient thoroughly enough to assess his or her exact medical need or range of options. In other words, overwork caused them to default into a “do something, anything” treatment plan.
That’s not good for the patient, it’s a waste of resources and an abuse of the system. And, according the doctors surveyed, it “likely contributed” to patients being transferred, to increased morbidity (higher incidence of a disease or disorder) or mortality.
As the researchers noted, as many as 98,000 hospital patients die every year because of preventable medical errors. (See our blogs on preventable surgical and diagnostic errors.) “[F]or resident physicians,” they wrote, “workload so heavy as to result in physician fatigue is associated with increased medical errors and has led to the implementation of work-hour restrictions.”
The survey also showed that:
- Nearly 1 in 5 respondents said they’d seen too many patients to the point where it adversely affected the quality of their hand-offs (communicating about patient status with the new doctors when one shift ends and another begins).
- One in 10 failed to note or act on critical lab results because of high patient volume.
- One in 10 failed to transfer a patient to a higher level of care.
- Nearly 1 in 5 said they thought their workload worsened patient satisfaction.
- Fourteen in 100 said their workload increased readmission rates (patients who are readmitted to the hospital within 30 days of being discharged).
- More than 1 in 10 said their workload worsened overall quality of care.
These are grim data, indeed. Being hospitalized is stressful, expensive and unpleasant enough without knowing how exhausted are the people responsible for making you well. They’re cutting corners on your ability to heal.
The researchers have a couple of suggestions for improving the situation: regularly evaluating workloads for attending physicians, and cutting health-care costs without increasing workloads to compensate for payment reductions.
In our opinion, the first is wish-list, perfect-world irony (who’s got the time to monitor people who don’t have the time not to need monitoring?), and the latter is an evergreen problem the system has long recognized and been unable to address.
The survey isn’t a conclusive diagnosis of the overworked doctor problem because its respondents chose to participate (it wasn’t a random sample), and, potentially, there are differences between someone’s perceived workload as it relates to a patient’s outcome versus an actual workload with actual outcomes.
Still. There’s a problem with doctors being able to do the best job they can with hospitalized patients. And at least for now, the best way to protect yourself and your loved ones is to monitor the care. Learn how by reading out two-part newsletter here and here.