Can Blockchain Help Reduce Physician Burnout? — Yes, But Only If Done Correctly
How to use behavioral economics to promote professional fulfillment and reduce “digital fatigue” in modern healthcare
Last week George, a colleague of mine asked me to help him find “the best wearable in the market” to monitor stress, fatigue and depression for a study he is conducting on physician burnout (a syndrome of emotional exhaustion, depersonalization and constant performance dissatisfaction).
I must admit that I spent way too much time finding him an answer, but during my search I learned 3 new things:
- There is a physician burnout crisis going on in American Medicine
- A supersaturated digital medical market has caused “digital fatigue”
- Blockchain can be a powerful solution if designed to promote professional fulfillment
#1. There is a Physician Burnout crisis going on in American Medicine
Throughout my 25 years of clinical practice, 8 colleagues have taken their life. Eight. But honestly, beyond the personal sense of loss, I never gave it much thought. Some colleagues were closer, others not; some were young residents, others were near retirement; 5 of them were men, 3 women; but all decided that dying was a better option than to continue to live and practice medicine.
I also never spoke about these deaths with anyone (not even with my wife who is a Professor in Anesthesiology) and I definitely never attributed these deaths to my work conditions. So when George told me about his study, I started to look into physician burnout and was stunned to learn that in the US every day a physician successfully commits suicide.
More so, I was wrong. Physician burnout is undeniably a workplace issue.
Physicians, who now spend over 50% of their time practicing “desktop medicine” instead of direct patient care, enter clinical practice healthy with a higher quality of life, lower rates of burnout and depression, and lower rates of cancer and cardiovascular disease. However once in practice, they register lower work-life satisfaction than the general population (40.9% vs 61.3%), higher rates of burnout (54.4% vs 28.4%), and the risk of suicide becomes 1.4 and 2.3 times higher for male and female physicians, respectively.
In addition, burned-out doctors are more likely to make medical errors, work less efficiently (absenteeism and presenteeism), refer their patients to other providers, increasing the overall complexity and with it, the cost of care. But most worryingly are at high risk of attrition, leaving medicine altogether and exacerbating the current shortage of physicians.
Not surprisingly and in response to this alarming trend, the Institute of Health Improvement (IHI), an organization that since 1991 has been working on solutions aimed to redesign healthcare into a system without errors, waste, delay and unsustainable costs, added a fourth to its original triple aims, namely:
- Better care
- Lower cost
- Better patient experience
- Better provider experience (added in 2017)
#2. A supersaturated digital medical market has caused “digital fatigue”
I started looking for a wearable device for George that would measure stress, fatigue and depression. I researched dozens mainstream products (like Apple, Garmin, Polar, Samsung to name a few), bearing in mind their accuracy and fidelity limitations.
Since I wasn’t sure if raw data would be available for analysis, I finally recommended the Empatica 4 (below) and just to be sure, I also looked at Embrace (a cheaper version), the Airo (buzzes when you are stressed) and Emvio (which has a nicer design but is still in pre-order).
This way-too-long-search was exhausting and I needed to relax. I suffered from a mild case of “digital fatigue”.
In an earlier post I mentioned that health information technology (HIT) has made physician lives harder (below). Yet the medical digital market continues to expand at a vertiginous rate of 200 new applications per day(!) and with over 350,000 health apps, 400 wearables and 3.5 billion downloads, it is impossible to follow the space.
Digital sensors are improving constantly, transforming medical devices like asthma inhalers and insulin pens into smart devices that are able to track usage and encourage adherence (or so they promise).
The hope is that this constant collection of real world data through connected sensors, wearables and mobile devices will create “digital biomarkers” that will predict, track and assess the effect of treatments on specific diseases.
The evidence, we hope, is on its way.
#3. Blockchain can be a powerful solution if designed to promote professional fulfillment
To understand how blockchain technology can help reduce physician burnout, one needs to understand its roots. As the name implies, physicians suffering from burnout feel as though a fire that once burned inside them has dwindled and perhaps even entirely extinguished. They report a sense of having “run out of gas,” as though they “have nothing left.” This decreased enthusiasm for work and growing cynicism is the manifestation of a low sense of personal accomplishment.
This is happening because medicine is not a job. It is not even a career. At its heart, medicine is a calling.
Therefore the response to burnout by recommending coping strategies focusing on the reduction of stress is dissatisfying and does not get to the problem’s real roots. (It is like providing symptomatic relief to a patient with chronic pain without ever addressing the underlying suffering or encouraging the development of life habits that foster a positive state of well-being).
Instead of merely reducing the bad in medical practice, we need to enhance the Good.
The use of monetary incentives alone to encourage physicians to deliver high care value is faulty as well and explains why Value-Based-Care initiatives are only partially adopted and less successful than envisioned.
Thus, blockchain technology has a unique opportunity to design a decentralized economy where the incentive’s focus is on promoting professional fulfillment. These incentive elements include professional recognition, social ranking and temporally tying financial rewards to meaningful institutional and community efforts (below).
Self-interest alone does not explain economic behavior and economic incentives should not be solely designed for financial self-interest. Successful incentives result from a complex interaction of self-interest and cultural intelligence, as reflected in the professional norms that enable human cooperation in a large-scale society.
If incentives are designed correctly, blockchain will not be just another technology, but a platform on which the medical profession can thrive. The alternative to that, as expressed by the prominent American physician Sir William Osler, is grim.
“Incentivizing [Medicine] with money is a self-fulfilling prophecy of cynicism. We must promote compassion, courage, and wisdom among our physicians before we make a sordid business of this high and sacred calling.”
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