Minimize the impact of EHR-induced stress

It may not be too surprising to hear that the rate of physician burnout is on the rise. What might be particularly surprising is the cause. Work-life balance has typically been identified as the primary culprit, but now burnout is more often linked directly to time spent engaged in computer documentation. A recent article in The New Yorker (Why Doctors Hate Their Computer) highlights the impact that computerization has had on physicians, healthcare workers, medical practices, and patients. The author highlights two alarming statistics: one is that healthcare workers spend twice as much time on the computer as they do interacting with patients. The other is that the average workday for family physicians is now at 11.5 hours-this is mostly attributed to the need to be behind a computer screen. 

Computerized records are not going away, so it is imperative that the healthcare profession develops strategies to mitigate and cope with the stress EHRs are causing-for themselves AND for patients. To do so, first identify what factors you have some level of control over and those that you do not. For the former, let’s look at a few strategies that you might employ, and for the latter, let’s consider what brain science has to offer us in the way of developing greater resiliency. 

For factors you can control:

• Brainstorm new ways that your staff can get more involved in easing the burden of documentation-related responsibilities. Maybe they can take on new responsibilities that not only help you, but also provide opportunities for their own professional growth and development.

• Prioritize face time with your patients. While there is expense involved in hiring a scribe, the rewards may far outweigh the costs by giving you more quality time with patients, lessening the amount of time you spend documenting, and allowing you to spend less time at the office.

• Acknowledge to staff and patients that you understand their frustration-labeling emotions helps mitigate their impact (i.e. lessens amygdala activation)

• Prioritize off-time-you need time to unwind, relax, travel, be with family, and so on.

For the stressors that you cannot control (i.e., EHRs are here to stay), here are some brain resilience practices to consider.

• Focus on your mindset. We all have a negativity bias-our brains are wired to pay more attention to threats and negative experiences, to feel them more intensely, and to remember them more than we do the positive. And under conditions of stress, that negativity bias gets even stronger, further exacerbating stress. It manifests in what gets our attention and what we focus on, whether it be outside events or in our self-talk. We need to be intentional about combating negative bias by deliberately noticing the good stuff and by “catching” ourselves and others doing things right. Frequent, specific, and genuine appreciation and acknowledgement goes a long way. Create positive expectations, express gratitude, and believe in yourself and others.

• Be present: A Harvard study found that the more time people spend in what is termed the “narrative” or “default” mode of thinking where our minds are focused on the past, the future, planning, social interactions, etc., the less happy we are. The more time spent in “direct experience” mode where we are focused on what is happening in the moment, the happier we are. So stay present- you, your staff, and your patients will appreciate it.

• Sleep: This is one of the most critical factors impacting our ability to cope with stress, especially ongoing stress. Aim for 7 to 8 hours a night and remember the strategies for getting a better night’s sleep-avoid alcohol before bedtime and excessive caffeine, limit exposure to light-emitting devices (like your computer!) before bed, exercise during the day, and spend time outdoors.

• Exercise: You know the physical and emotional benefits of regular exercise. Did you also know that it is associated with improved cognitive functioning, neuroplasticity, and enhanced social connections? Exercise helps prevent aging effects in the brain because it encourages release of brain derived neurotrophic factor (BDNF) helping to strengthen the telomeres on chromosomes.

• Diet: Fasting and caloric restriction are also associated with BDNF production and tends to improve mood, sleep, and life satisfaction. Even going 12 hours of fasting between dinner and breakfast can help.

• Meditate and practice mindfulness: The evidence is convincing- developing a regular habit of meditation lessens amygdala reactivity and strengthens emotional regulation. That adds up to lessening the negative impact of stress and improved coping.

• Laugh: It really is good medicine. Laughter helps build brain resiliency and improves cognitive functioning. So go ahead, tell a joke, read a funny story and watch comedy.

While you might not incorporate all the suggestions above, start with just one and turn it into a habit. Take advantage of neuroplasticity and your resilient brain.

Catherine Hambley, PhD, is a consulting psychologist who offers brain-based strategies to organizations, leaders, teams, and healthcare providers to improve their effectiveness and promote greater success. She can be reached at catherine.hambley@gmail.com