The Patient's Problem List is NOT a List of Problems - Physician Burnout is Not A Problem Either

Posted by Dike Drummond MD

problem-list-not-problems-dilemma-stop-physician-burnout_opt150w.jpgThe Patient’s Problem List is NOT a List of Problems -  - Physician Burnout is Not A Problem Either !

The beginning of all wisdom starts by calling things by their right name. ~ Confucius

Healthcare's Pervasive Misuse of the Word "PROBLEM"

The patient’s Problem List is NOT a list of problems at all.

As a matter of fact, when you see a patient for a true problem, the last thing you would do is enter that onto their Problem List.

In this blog post, let me show why every item on the Problem List is something other than a problem -- and the extremely valuable physician burnout lesson we can learn by correcting this very common mistake.

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Learn …

  • Why “PROBLEM” – is perhaps the most frequently mis-used word in the English language
  • How to avoid the futile search for a solutions when none exist
  • The true nature – and real name – of these non-problems
  • Where to focus your energy and brain power to address them successfully

PROBLEM = a statement requiring a solution, usually by means of a mathematical operation or geometric construction

problem-solution-dilemma-strategy-stop-physician-burnout.jpgA fundamental feature of a problem is that it has a solution. When you apply a solution to a problem, what should happen to the problem? It goes away right? No problem!

The word problem comes from mathematics. Example: 2 + 2 is what?

Correct. The answer is four. Problem solved. Give me another problem please.

Answer the following for me as quickly as you can

  • 3 + 3 = ?
  • 3 X 6 = ?
  • The solution to your patient Cheryl’s morbid obesity = ?

I will bet that last one made you pause for a second. No obvious, simple, one-shot answer, right?

You have no solution for a simple reason. Morbid obesity is not a problem

However if your patient is morbidly obese, you will put that on her Problem List. Why do we make this mistake – this labeling error - for all our patients?

It is not just doctors. The incorrect use of the word Problem is everywhere in English.

It causes all of us to struggle and fail when addressing anything more complex than a grade school math assignment. This is especially true when doctors and healthcare systems keep trying to find a Solution to Physician Burnout ... ARRRGGGHHHH

But, I digress ... let's refocus on the Problem List and go a little further ...

Can you give me an example of a true Patient Problem? 

What is a clinical issue that can be solved in a single action. How about this?


dilemma-vs-problem-physician-burnout-dike-drummond.jpgA pointing abscess

A golf ball sized boil with a single white head the size of your pinky fingernail on the butt cheek of your same patient – Cheryl. Is this actually a problem? Can we fix it in a single step? You betcha !

What is the solution here?

I & D. Open it up and squeeze the pus out … right.

And don’t you just LOVE a boil or two in your practice day? ( … be honest here - how much would you pay me to sprinkle three boils a day into your schedule??) How often do you get to solve a patient's problem, snap off your gloves, wash your hands, move on to the next task --  knowing this one ... is complete?

Would you put “boil on the butt” on Cheryl’s Problem List?
Yes or No?

Hmmm ....

  • Her morbid obesity – not a problem – goes on the Problem List
  • Her boil – definitely a problem - does NOT go on the Problem List

What gives here?

The Patient’s Problem List is NOT a List of Problems

It is a list of DILEMMA’s

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= “a never ending balancing act”, which by its very nature does not have a solution.

The balancing act of obesity is a simple equation:
the calories you eat vs. the calories you burn.

Tip the scales one way and you lose weight, tip them the opposite way and you gain. What you cannot do is apply a solution – that one thing you do one time and you never have to worry about your weight again.

Physician burnout is another DILEMMA.

The balancing act here is also simple. It is the energy you burn each day vs. your ability to recharge. Depending on which way your teeter totter leans, you either burn out or you maintain a healthy energy level.


Let’s go further.

ANYTHING You Can’t Solve with a Single Action

  • We are surrounded by things we call problems that are not.
  • So we search for solutions when none exist.
  • And blame ourselves, our teams and our patients for not being able to figure it out.

Examples of common PROBLEMS DILEMMAS

World peace, the economy, religious extremism, EMR, your call rotation, your compensation formula, the US tax code, polymyalgia rheumatica, hypertension, your level of physical fitness, your Net Worth, parenting, ADD, drug addiction ...

I could go on and on here. There are tens of thousands of complex issues we routinely call "a problem" that become much easier to address when you call them by their right name.

How can you address a Dilemma?

You can't solve it for a simple reason ... it isn't a Problem.

Focus on a different “S” word ------ STRATEGY
3 – 5 actions you deploy together, to maintain the balance you seek


Let’s look at physician burnout specifically as we build the layers of a successful strategy.

Two Keys to a Strategy That Works

  • If you don’t like your current energy balance, Einstein’s Insanity Definition says that you would have to take NEW Actions to reach a NEW energy balance point.
  • Since the balancing act of physician burnout Never Ends, you will also need to turn these new actions into HABITS.

FYI: this is the core of a successful coaching relationship. We start with a physician who is exhausted, help them choose 3 – 5 new actions to reach a positive energy level, then turn those into solid habits – all over a time frame of 6 – 9 months.

This is another Mind Flip for Doctors

  • When you find yourself using the word PROBLEM
  • Ask, “Is this actually a PROBLEM? Is there a one-step SOLUTION?
  • Or is this a DILEMMA – a never ending balancing act?”
  • When you name the DILEMMA, STOP looking for a SOLUTION
  • Instead focus yourself, your teams and your patients on an effective STRATEGY
  • Brainstorm 3 – 5 NEW ACTIONS to reach the balance that you seek
  • Turn them into HABITS

You can start this mind flip right away with every item on every one of your patients’ problem lists … or we could use the right word and call it their Dilemma List - probably not going to happen ☹.

BTW, here are 235 ways to prevent physician burnout. Any of them could be a component of your strategy.



Type in one thing you have been calling a PROBLEM that you now see is a classic DILEMMA?


Tags: physician burnout prevention, stop physician burnout