Physician Burnout and EMR: if you judge a fish by its ability to climb a tree ...

Posted by Dike Drummond MD

electronic-medical-records-team-based-care-stop-physician-burnout-opt150W"Everybody is a Genius.
But If You Judge a Fish by Its Ability to Climb a Tree, It Will Live Its Whole Life Believing that It is Stupid"

~ Albert Einstein (?)

The first time I saw this quote two things became clear to me in a flash.

  • The logic behind the quote is undeniable
  • AND the author is obviously talking about physicians and the Electronic Medical Record

Every week I talk with CMO's and other senior physician leaders who simply cannot understand why some of their doctors "struggle to get out of the room,  stay on time,  see a minimum number of patients per day, over-charting" and more. 

And every week we meet hard working doctors who are haunted by the simple doubts, "what is wrong with me that I can't get my charts done?" and with the next breath, "I'm not sure how much longer I can keep going like this."

This stand off is smack in the middle of a gaping blind spot we see in nearly every healthcare organization. 


Practicing Medicine
and Data Entry into an Electronic Medical Record
are two separate skill sets
(And one of them is WAAAY more important than the other)

Is it actually some sort of inscrutable riddle, a conundrum, a freaking MYSTERY why doctors struggle with the Electronic Medical Record and other digital forms of overload??

The answer is simple:

Many leaders are judging a fish by its ability to climb a tree

  • Doctors are highly trained practitioners of clinical medicine and cutting edge medical procedures
  • We gave up our 20's to learn how to practice our specialty, dozens of times a day, with patients who are scared, sick, suffering, dying
  • And deal with their family members who are often in extremis with fear and grief
  • And leaders want us to be data entry clerks too
  • With software systems that are such a collective nightmare, everyone agrees they are the single largest cause of our physician burnout epidemic

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A doctor's value to the organization is often judged by the common inability to keep up with this digital brain damage

This "problem" has already been "solved" by the way!

It's even crazier when you consider the management mantra for every other member of the care team.

"Well gosh darn it, we gotta get these people PRACTICING AT THE TOP OF THEIR LICENSE."

That appears to be a useful strategy for every other member of the care team: the MA's and Nurses and Techs. But there is a giant blind spot when it comes to the doctors - in most organizations.

The doctors are left to struggle through the EMR's perfect clickstorm in their jammies, at home, after they put the kids to bed.

How would things be different if the Doctors only practiced at the "top of their license" too? 

First and foremost, you would not see a doctor at a computer.
Data entry does not take board certification.

The key here is Judge a Fish by their Ability to be a Fish
and let someone else climb the (EMR) tree

The implementation of EMR is to blame for a legitimate doubling of the workload on the care team

What I don't understand is why organizations continue wholesale avoidance of a proven solution to this digital overload as old as EMR itself.

I am talking about Team Based Practice Transformation

Here is one of my favorite quotes from one of the pioneers of Team Based Care in the outpatient world, Dr. Jim Jerzak and his team at Bellin Health.

Jim-Jerzak-Bellin-Health-Team-based-care-physician-burnoutThings get so much easier if you can just keep the doctors out of the chart.

Jim Jerzak MD Bellin Health


Here's a YouTube video of an outpatient office visit in the Bellin Health Team Based Care Clinic.

It is worth the ten minutes to watch exactly what happens - and what does not happen - in this typical patient encounter.

Notice how your jaw drops when you realize ... the doctor does not touch the computer at any point in the visit. Not once. 

And despite this remarkable work flow ... the chart is complete at the end of the visit.


Team Based Care Projects are so successful at alleviating Physician Burnout, turnover, patient satisfaction issues and more ...  that we can say this with authority ...

If your organization employs more than 10 doctors ...

... and you are NOT running a Team Based Care Pilot Project somewhere in your system to see if it will work for you and your people ...

Then your organization simply does not understand the Quadruple Aim

If you are not running a Team Based Care Pilot -- and persist in wondering why the doctors are unable to keep up with their charts -- you are failing your doctors and your patients.

Please stop blaming the victims in this situation.
Let the fish be a fish.
Keep your doctors out of the charts.
Allow them to practice at the top of their license.

And correct the mismatch between the sheer amount of work to be done and the number of hands on deck.


If you want to learn how a Team Based Care Pilot fits into
a System-Wide Burnout Prevention Strategy in compliance with
the recent National Academy of Medicine recommendations ...

1) Email:

2) Phone: 206-430-1905

3) Use This Form to Contact Us Directly


Team Based Care Resources:

Here are three sources of information and support on Team Based Care you need to know about. (I have no financial relationship of any kind with any of these groups AND I have met all of them and can vouch for the quality of their work)

If you would like a direct introduction and a warm handoff to any of these visionary leaders, please let me know and we can connect you.



Does your organization have a Team Based Care pilot in action?
What difference does adequate staffing make to the doctors in the project?
If your organization does not have a Team Based Care pilot up and running ... what is the justification your leadership team has for this inaction?

For information on the origins of the quote
that triggered this blog post, check this out



Tags: EMR, stop physician burnout