Maintaining Physician Boundaries in the Age of Digital Healthcare

In the past twelve years, over 90% of hospitals in the United States have become computerized [1]. Electronic Health Records, or EHR, have become a prominent feature of this digitalization [1]. On EHR platforms, such as Epic, health professionals find much of their traditionally dispersed clinical work collected into a single software platform [1]. In our age of digital healthcare, some clinicians can rely on a single computer program to issue prescriptions for patients, fill out a prior authorization form, communicate with other physicians, and more [2]. 

Although EHRs may be expected to lighten physicians’ workload, these digital healthcare programs often contribute to greater amounts of uncompensated labor outside of traditional working hours [2]. A study conducted at the University of Arizona College of Medicine – Phoenix revealed that EHRs can lead to over 33 hours a month of after-hours work for family physicians [3]. The mounting list of patient call messages that pop up in a physician’s virtual inbox is a major contributor to what Berkeley psychologist Christina Maslach has called “clinician burnout” [1], [3]. The condition is defined by depersonalization, an overall diminishment of personal efficacy, and emotional exhaustion [3]. In 2018, over 54% of physicians reported experiencing at minimum one of those three symptoms, compared with the 46% documented in 2011 [1]. 

While some of the most effective solutions to reducing burnout and reestablishing work-life boundaries involve changing the nature of EHR technology, these solutions are difficult and time-consuming to execute [4]. Regardless, researchers have stressed that there are a great number of lifestyle changes physicians can adopt to allow them to navigate the digitalization of healthcare without suffering from burnout. For instance, one study extolls the virtues of participating in physical exercise, particularly in the form of manageable activities such as lunchtime walks, spinning, and swimming [4]. Another recommendation includes being more mindful when engaging in work, which could look like setting limits on work done in a day and preventing oneself from doing work at home, if possible [4]. Lastly, engaging in EHR retraining every so often can make navigating one’s daily workflow much easier [4]. 

Another risk associated with digital healthcare is the increasing frequency with which patients have their clinician’s phone numbers or email addresses. In a survey conducted across 20 specialist clinics in the United Kingdom, researchers identified that doctors whose patients had access to their phone or email logged more time completing after-hours work [5]. On the other hand, patients having more flexibility in contacting their physicians also contributes to increases in patient empowerment and autonomy, as well as a more trust-driven relationship between patients and doctors [5]. The question, then, becomes how to navigate the balance between accessibility and privacy.  

In response to the shrinking separation between their personal and work lives, numerous physicians have defined strict rules for themselves that restrict their ability to communicate with patients outside of work [5]. Often, this comes in the form of preventing themselves from accessing their emails outside of work hours [5]. These rules can also extend to limiting cell phone time spent communicating with patients. Given that all contact with patients must be strictly related to healthcare, the ethical guidelines restricting the patient-physician relationship can be invoked when asking to limit communication [6]. Admittedly, a complicating factor in distancing oneself from one’s patients is a physician’s legal and ethical obligation to respond to imperiled patients who may send telephonic notice of an emergency after-hours. Regardless, researchers emphasize the importance of doctors establishing boundaries and reassuring themselves that other medical professionals are available when they are not [5]. 

References 

[1] A. Gawande, “Why Doctors Hate Their Computers,” November 5, 2018. [Online]. Available: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers. [Accessed: September 4, 2020]. 

[2] C. Jason, “High EHR Inbox Volume is the Leading Cause of Clinician Burnout,” July 29, 2020. [Online]. Available: https://ehrintelligence.com/news/high-ehr-inbox-volume-is-the-leading-cause-of-clinician-burnout. [Accessed: September 4, 2020]. 

[3] C. Jason, “After-Work EHR Use Drives Workload Burden in Family Medicine Docs,” February 29, 2020. [Online]. Available: https://ehrintelligence.com/news/after-work-ehr-use-drives-workload-burden-in-family-medicine-docs. [Accessed: September 4, 2020]. 

[4] P. J. Kroth et al., "The Electronic Elephant in the Room: Physicians and the Electronic Health Record," JAMIA Open, vol. 1, no. 1, p. 49-56, July 2018. [Online]. Available: http://doi.org/10.1093/jamiaopen/ooy016. [Accessed September 4, 2020]. 

[5] A. Ignatowicz et al., "Ethical Implications of Digital Communication for the Patient-Client Relationship: Analysis of Interviews with Clinicians and Young Adults with Long Term Conditions," BMC Medical Ethics, vol. 19, no. 2, p. 1-9, February 2018. [Online]. Available: http://doi.org/10.1186/s12910-018-0250-0. [Accessed September 4, 2020]. 

[6] R. H. Ellaway et al., "Exploring Digital Professionalism," Medical Teacher, vol. 37, no. 9, p. 844-849, June 2015. [Online]. Available: http://doi.org/10.3109/0142159X.2015.1044956. [Accessed September 4, 2020].