DR. LAURIE DRILL-MELLUM
Today’s clinicians face tremendous pressure to stay on top of advances in technology - most notably, the wide-scale adoption of the electronic health record. At the same time, doctors, nurses and other nurses are expected to maintain a present and human connection. Dr. Laurie Drill-Mellum is our guest in the latest episode of Currents & Currencies and she shares her insights on how more empathy and support for health care providers will ultimately result in healthier patients.
Dr. Laurie Drill-Mellum is Chief Medical Officer for Constellation, Inc., the Midwest’s largest provider of medical liability insurance. She has seen spent more than three decades as a practicing physician.
Podcast Transcript
JULIE MACKENZIE, CEO OF MINDSAILING: Welcome back to another edition of Currents and Currencies, a podcast for leaders navigating sea change. I'm joined today by Dr. Laurie Drill-Mellum, chief medical officer for Constellation, the Midwest's largest provider of medical liability insurance.
DR. LAURIE DRILL-MELLUM, CMO OF CONSTELLATION: Thank you and it's great to be here.
MINDSAILING: Well thanks for joining us. The question today is as you look out on the medical landscape and particularly thinking about physicians and nurses and people who are delivering care, what are some of the dynamics that you see that are causing disruption? And then to oppose that, what are some of the strategies that leaders or organizations can employ to help build resilience and create a more positive future for health care?
DRILL-MELLUM: That's a multi-layered question you just asked. So, I think one of the very influential dynamics that is causing disruption not only in the delivery, but in the reception of health care is the rapid development and use of technology in health care. And that ends up influencing people who are - what I like to call - on the frontline of care: nurses, physicians, other health care providers in the way that they deliver care. So, an example I think anyone that studied the current practice of medicine or nursing knows that there's a lot of stress on both nurses and physicians as they try to balance the use of technology in that delivery of care. And what patients and families are looking for in a - what they assume will be the use of technology but they're also looking for the human connection in health care.
And if you look at what's driving lots of challenges for nurses and physicians in the current era it's technology that again has lots of great benefits but also pulls them out of relationship and away from the bedside and consumes lots and lots of time. So for example, with physicians when they're seeing a patient or talking with a patient and their family members, many of them spend a lot of time focused on documentation on the electronic health record (EHR). There's actually a really nice opinion piece that was just published by Danielle Ofri who's a physician that works at Bellevue in New York. And she called up the fact that the Journal of the American Medical Association featured a drawing by a child seeing her pediatrician several years ago, and the picture was of this pediatrician with the back facing a child on the exam table working at the computer. And that was this child's perception of her visit to the doctor and this is an absolute 180-degree sharp contrast to what drew many people into nursing and medicine in the first place, which was there's this very classic painting of a physician who's sitting at the bedside of a very ill child tending to that child and her parents are in the background very worried. So that kind of relationship has changed substantially. And it’s not really fulfilling in some ways a deep, professional calling for nurses and physicians.
MINDSAILING: So I'm hearing you say the caregivers - the nurses and the doctors and others - who've come into the field to provide care, part of their calling is this empathetic connection that they're going to have with their patients. And also patients and their families also seek that empathetic connection and feel that as integral to their care along with the accuracy that the technology should help.
DRILL-MELLUM: Yes, absolutely. So, what you said first is that that sort of connected relationship is one that historically has drawn people into both nursing and medicine and it's sort of mutually satisfying. That being said, in addition to that, patients and families sadly and incorrectly at times believe that this technology that's being used, which again is very helpful and important, somehow magically communicates all over the place. And they assume that, for example, if they've been seen at another facility or had lab work or x-rays or whatever done that somehow that data information magically gets into their record. Now, if they're in a closed system, that may be true; it may be accessible, but for the most part it's not. So we're kind of at this, I would just say, it's an uncomfortable place where we haven't quite figured out how to leverage the technology in the most efficient, appropriate way and I think that that will come with time. I think that maybe even 50 years from now, we'll look back and say “I can't believe we spent all this time doing all this non-essential work.” Or not seeing what was clearly there, I mean you know we'll have the benefit of the retrospective scope, but I think we're just at this uncomfortable time and that being said, we're also at an incredibly exciting time.
So you may have just seen this newly announced partnership between Google and the Mayo Clinic, where they're going to be using a lot of artificial intelligence to mine data that's been stored on patient characteristics and their diseases and treatments to look for better ways to predict illness, disease, response to treatments, ultimately ferreting out what's good and what's not good. So there's lots of great potential of this. There's lots of texture, yeah.
MINDSAILING: And I'm hearing you say like, Google and Mayo - they're two giants what could you not want to have those two come together, but at some point, that intelligence that the technology is creating goes to the doctor and that it seems to be part of the handoff. Is there anything that you see that doctors and nurses or other chief medical officers, as they're you know thinking about their staff strategies that they might think about? So that great intelligence that they get, you know they're not a machine they're a human, right? They have to go in and access it and then they have to connect with another humans and translate that on and that other human may make all sorts of other choices, so how can we help these doctors and nurses?
DRILL-MELLUM: So, I mean it's just interesting that Mayo as a thread in this conversation right now because Mayo has been a leader in researching around contributors to physician burnout. There's a very well-researched tool called the Maslach [Physician] Burnout Inventory (MBI) and it measures emotional exhaustion, depersonalization and a low sense of personal accomplishment. And there is a group of physicians at Mayo who have researched this over many years and have found that this is an increasing phenomenon. And they're also researching ways, not only sort of the epidemiology of it is, how come, and are those feelings of burnout, what are the contributing factors, but then ways to address it.
So when I talk about Mayo, sometimes I add them for all this very good work and I worry for them a little bit like I do for many large health care entities that there may be a very large challenge in staffing their destination Medical Center. It has been called out in articles over the years - as we invest a lot of resources and developing this destination Medical Center here in Minnesota, in Rochester, is that they're going to need a lot of people to staff it. And so there's been something called the “Triple Aim” which is: how to improve population health, how to increase efficiency [decrease costs] and how to improve patient experience. And many of us that study this issue, and some who have been broadly published in this area, say that in addition to what's called the Triple Aim, those three concerns, we need to have a quadruple aim, which is: you need to care for the people delivering the care. You only get so far in the Triple Aim - improve population health, improved efficiency and decreased cost, and improve patient experience. You only get so far if you don't attend to the people that are on the front lines of care, delivery in the care.
So, when we look at what drives a lot of that discontent it's a major issue that I alluded to earlier and that is the EHR workflow that's impeded by the current electronic health record. That contributes about 80% in surveys to feelings of distress. Regret is a user experience that they're having as those are experienced. You often may hear that you want people to work up to their level of training, okay, so you've got physicians and nurses functioning as stenographers in that role and it's pulling them away from the actual human connection. So there have been multiple studies that show by increasing help to some of the most highly trained professionals in our society (i.e. physicians), it would be wise to put more resources to supporting them to do the things that they've been trained to do, not to have them toiling away on their electronic health records either - during their clinic hours which pulls them out of relationship with their patients and families. There have been a lot at time-work studies done because you can see when people are actually doing their work on their EHR. And for physicians, it's termed “pajama time” or “Saturday date night time” when physicians are actually going home after their kids - are if they have children - are put to bed, they're doing a lot of their documentation at night or on the weekends. And so they don't have the opportunity to rest and rejuvenate themselves the way a lot of people do on the weekend, and I mean, physicians have that problem anyway. But anyways, I think that there are fixes for this in terms of support, although you put that up against this huge problem of very low unemployment right now so that's another driving force. So they just ran in, just the American economy, we have very low unemployment. We you know people can't find people to staff all sorts of things, including, you know, administrative support.
MINDSAILING: I think that's something we could have you back to discuss is the it rise in the aging population and how we're going to find the caregivers that we need to care for it. I just want to close out, I hear this friction between the technology and the care provider and I think there are some in the technology industry that are trying to bring in artificial intelligence and natural language processing in order to facilitate. Is there anything else, let's say, that that you could think culturally that these organizations might bring forward to support physicians and nurses, just to close us out?
DRILL-MELLUM: Yes, so I think that there is a huge problem and not just in medicine, but I would argue this all of society right now. It’s of not really seeing people, not seeing people as individuals and seeing them more as cogs, being much more comfortable connecting with people on social media and as some people say, you know, that doesn't really provide true social human connection. It's an exchange of information, but it doesn't provide connection that is satisfying to people. So in the current practice of medicine, more and more physicians are now employed by larger organizations. That was has been a movement over the last 20 years for all sorts of reasons, but one of the challenges for physicians and for lots of people who went into medicine looking for more autonomy, control, mastery, purpose - you see when they become an employee, an employed provider of health care, sometimes that can be disconnecting.
Sure, if they're not seen, so there is I think a challenge and an opportunity for people in health care administrations to try and bridge what I would call the “chasm.” There's chasms between all sorts of professional groups and I would say in many organizations, there's an opportunity to sort of reach across the chasm - whether it's between clinicians and administrators or physicians and nurses or physicians and nurses and patients and families. It's “how do we see each other and respect each other as people and individuals first” and by doing that, you could make it a lot more easy to communicate and easy to get along.
MINDSAILING: I think that brings us right back to the original philosophy of empathy and human connection.
DRILL-MELLUM: That's right, that's absolutely right.
MINDSAILING: It seems to be a pathway worth going down. Laurie, thank you so much for joining us for the Currents and Currencies discussion. And thanks to our audience for listening. You can hear this podcast and other interviews in the series by visiting mindsailing.com/podcasts.