Caring for Patients Takes Time: Dr. Peabody Says So!

Abstract

The good physician knows his patient through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction in the practice of medicine.One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.Francis W. Peabody [1].The emotional exhaustion of present-day physicians and physicians-in-training is well described and of genuine concern. It is assumed, however, that the origin of exhaustion, cynicism, compassion fatigue, and burnout is patient care or "service" burden. The Accreditation Council for Graduate Medical Education cautions program directors to limit the number of hours in which resident physicians engage in patient care responsibilities. The guidelines imply that caring for patients is intrinsically burdensome-the notion of service is represented as onerous-as mere labor, not as an act of professionalism in which our efforts are dedicated to the wellbeing of others and a greater good. The guidelines were introduced, quite correctly, when tragic mistakes in patient care and the exploitative practices of some residency programs were recognized. Nevertheless, Dr. Peabody's remarks in 1927 [1], nearly a century ago, remind us that our aim should not be to limit contact with patients but to provide excellent patient care and to foster great clinical skills in our trainees. Moreover, what if, as Dr. Peabody suggests, by limiting the contact that we have with our patients, we have damaged the deepest source of satisfaction in our work as physicians?Taken one step further, what if the ever-expanding administrative responsibilities associated with clinical care are diminishing time spent with patients as well as contributing to the emotional exhaustion, depersonalization, and lack of sense of personal achievement of physicians? The time allocated to maintenance of documentation in the electronic medical record, interactions with insurers, and fulfillment of regulatory requirements, among other activities, has grown dramatically over the past decades. A recent RAND study [2] found that physicians experienced many obstacles to providing high-quality care and that these barriers were a major source of dissatisfaction as a professional. Physicians in that study described how the pressure to provide greater quantity of service for a greater number of patients and to engage in extensive administrative activities effectively decreased the time and attention they could spend with each patient, which in turn detracted from the quality of care in some cases. Moreover, limiting hours and contact with patients can set up problems-more mistakes may be precipitated by, for example, multiple hand offs that occur with "shift work" and not really knowing and caring for patients longitudinally, even through a critical episode of illness. A personal sense of fulfillment and integrity is likely compromised when a

Innovative Training with Virtual Patients in Transcultural Psychiatry: The Impact on Resident Psychiatrists’ Confidence

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Power of Psychotherapy: on the Couch with a Neuropsychiatrist!

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