Healthcare is about taking care of people’s health. In practice, our healthcare system takes care of people who are unwell until they can manage again. Mostly people do get better. Healthcare spends about 10% of GDP per year ($185.4b in 2018)1, largely ignoring the maxim, prevention is better than a cure, with just 1.34% of health expenditure going to prevention programs2.
While technology in healthcare has and is evolving rapidly, and the value of understanding the patient’s experience has been brought into the spotlight in recent years, the wellbeing of the providers, in particular doctors, has largely been ignored, bringing new meaning to another healthcare tenant: ‘do no harm’ and threatening the capacity of the system.
In the last decade, health has focused its energy on improving the patient experience, recognising that how the patient feels about how they were treated when they were sick and vulnerable, has an impact on their ability to get better. Research has shown clearly that when the patient feels respected - seen and heard as a person in their own right with values, emotions and opinions, and as a consequence is included in decision making about their health, they have better perceived and real health outcomes3.
In other words, relationship is an active agent in providing the best healthcare for patients. The attitude and the systems that have evolved out of this near universal commitment to patient-centred care has reduced errors and been a powerful way to deliver more often on the medical commitment of do no harm for patients. While the research supports patient centred care, and it is the right thing to do for patients, it is time for the next step in the evolution of health, as a human centred endeavour. As is often the case, when we focus on one thing, we are prone to miss something else. The providers of healthcare are humans too. In the effort to continuously improve the delivery of care to patients we may have in fact done harm to our doctors.
Before COVID19 about 50% of doctors experienced the symptoms of burnout in any given year in many countries around the world4. This figure has gone up significantly in some countries during 2020. Add to this the very distressing reality that doctor suicide is consistently higher than that of the general population around the world5. (Nurses also experience symptoms of burnout, though the rate varies across settings6 ).
Our frontline staff have been up close and personal with COVID for a year or more now. Even those who have not cared for anyone with a possible COVID diagnosis, have thought a lot about when that day would come and what it might mean for them, if it did. The projected mental health crisis for frontline medical staff is expected to last at least another two years after the pandemic ends.
In Australia we already had an existing medical workforce challenge before the pandemic, especially when it came to doctors and nurses (and some other healthcare professionals) in regional and rural areas. Regional areas around the country have GP wait times of 6-8 weeks and waiting lists of months for consults with visiting specialists or for surgery. For the doctor this is a never-ending burden of worry and pressure.
Many doctors are unable to gain a position in the specialty training program of their Choice, despite years of endeavour completing research or other short courses to distinguish themselves from their peers in a highly competitive professional environment. As a result of anxiety experienced when confronted by a pandemic, lack of suitable career progression, too many patients and high rates of burnout, an increasing number of doctors are deciding to leave medical practice, taking their skills to other creative and technological careers.
Healthcare is undergoing enormous technological change from AI, machine learning, virtual technologies, big data, neural network learning, internet-based tech like blockchain, new cell and gene therapies. Whether we are ready for it or not, healthcare is being disrupted, innovated, and transformed in a myriad of ways all at once.
The most important question might be are the humans up to it? Can the medical workforce keep pace and stay well? Will they want to?
We already know that relationship is key to patients getting better. Relationship is also critical to healthcare provider wellbeing. Being seen, heard, valued and cared for are basic human needs that all healthcare professionals also need if they are to stay well and continue to deliver effective healthcare. Human factors such as relationship and connection, remain relevant for healthcare, whatever technological advances might be made.
Healthcare provision around the world is decentralising from hospitals and coming closer to people’s homes. In the age of personalised medicine, wearable devices and google, patients can access much more information about their own bodies, track their own data and learn how to respond to it using Apps and a range of care providers. In this age of social media comment and patient ratings, the level of service expectation is higher, putting continual pressure on providers of healthcare, perhaps even dehumanising them at times.
There are in excess of 126,000 doctors in Australia. It is impossible to speak of them as a single homogeneous group. The doctors who are able to join in effective partnership with patients and who are able to work with augmented technologies will have a future in medicine. Doctors will need to embrace the rapid and changing imposition of technology, seek out support staff such as scribes, health, and life coaches and nurse practitioners to help them and some will choose to leave medicine, adapting their skills to other careers.
It is incumbent on leaders in health to transform the way they employ and relate to their medical workforce if they wish to have access to these human resources into the near, and long-term future. The current models of training and employing doctors, do not appear to be helping doctors to stay well or to invite them to maintain discretionary effort in the service of their patients or their organisations. Well doctors who feel valued and supported achieve better health outcomes for their patients, better results for their organisation, can adapt to change and stay working in healthcare.
The augmented healthcare of the future will rely on skilled healthcare professionals who are excellent at building relationships with patients and colleagues – including health and life coaches and other more traditional healthcare professionals, researchers and importantly developers of technology.
There are examples of healthcare organisations taking this principal of prioritising wellbeing of providers seriously in the U.S. Organisations like the Cleveland Clinic and the Mayo Clinic have made long term investigations and investments into what makes healthcare sustainable and fulfilling for doctors, and to understanding if those factors reduce burnout.
The majority of healthcare organisations in Australia are yet to demonstrate the same committed endeavour or systemic priority, to doctor wellbeing as the cornerstone of their organisation’s survival and evolution into the age of AI. Putting doctor wellbeing first has the potential to alter healthcare in the same way Paul O’Neill’s focus on safety changed Alcoa and ushered in a new era in leadership.
Sharee Johnson is Australia’s leading doctor coach. She is a registered psychologist who works with doctors and healthcare leaders including medical colleges and healthcare organisations large and small.
For more information, please contact Sharee Johnson on
3 https://pubmed.ncbi.nlm.nih.gov/26394978/ and https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3818-y
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682395/ - The symptoms of burnout include exhaustion, cynicism, hostility or negativity about work and reduced efficacy.
6 https://journals.rcni.com/emergency-nurse/nurse-burnout-and-the-working-environmenten2011.09.19.5.30.c8704 https://www.mdpi.com/1660-4601/15/12/2800