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Innovation Update

Improving Patient Care and Physician Resilience through Effective Veteran-Centered Communication and Documentation Practices

Burnout: a state of breakdown like a pine forest after a wildfire. Tree trunks standing charred and black having lost their hold on life. It’s a bleak and forlorn landscape.

Resilience: like a rubber band, it may become stretched to the breaking point, but once tension is released, it returns to its original shape and elasticity. Unlike burnout, resilience is a renewable resource, a place of restoration and comfort.

Our VA project was designed to look at the relationships between exam room documentation practices, patient- and relationship-centered care principles, and resilience. Computers have been used in clinical practice for decades, mostly in the back office, not as a dominant feature of the clinical encounter. As demands for throughput and numerous documentation requirements have expanded, computers and the electronic health record (EHR) are playing an increasingly visible role in medical visits, so much so, that in one of our early studies, we found that some primary care physicians (PCPs) spent as much as 80 percent of the visit interacting with the computer screen rather than the patient. This pattern of practice is at odds with the commitment of VA and other healthcare organizations to include patient centeredness as a quality measure. In addition to the exam room, there is evidence that PCPs spend an average of 1 to 2 hours at home completing their electronic documentation.

One of the early findings from our current study is that in responding to the complexities of documenting while doctoring, some PCPs have developed ways of remaining patient and relationship focused and at the same time producing highly accurate and complete notes. They also continue to find joy in their practice of medicine. We are now at work converting our observations into a curriculum that will help physicians who are stretched to the max lessen the tensions associated with documenting care in the midst of giving it, and in so doing find renewal and joy in the practice of medicine.