The other office

Abstract

Across recent decades, profound changes in the practice of medicine have been accompanied by parallel developments in the daily mental efforts of medical professionals. Using visual metaphors and hand-drawn illustrations, the author explores the evolution of one physician's brain over the past 25 years. At the completion of training, the patient-practitioner relationship, medical knowledge, and care decisions dominated clinician thought, time, and effort. During the 1990's, the growing constraints of third-party payers and government regulations presented new challenges to delivering relationship-based care. Over the past decade, the electronic health record (EHR) has added further cognitive complexity, disrupted human relationships, and contributed significantly to the current epidemic of clinician burnout. Solutions to these challenges include rethinking education, documentation, professional standards, institutional barriers, and regulatory mandates. It is important to pursue all solutions with the underlying premise of protecting healing relationships as the foundation of clinical care.

Figure 1.

The training years Illustration by Elizabeth T. Toll.

Figure 2.

The third-party payer Illustration by Elizabeth T. Toll.

Figure 3.

The EHR years Illustration by Elizabeth T. Toll.