The Overburdened Physician: Why Addressing “Spiritual Distress” Requires a Systemic Shift, Not More Checklists
The call to integrate a more holistic view of patient well-being into medical care is a vital one. as Dr. Rachel Dolhun of the Michael J.Fox Foundation eloquently points out, neglecting a patient’s spirituality – their search for meaning, connection, and purpose – risks incomplete care and delayed interventions. However, the current approach to expanding the scope of primary care is creating a different kind of harm: physician burnout and diluted quality of care.
The recent STAT News article, “Doctors need to ask patients about chatbots,” exemplifies this growing trend. While the authors, Saneha Borisuth and Nina Vasan, rightly highlight the potential mental health impacts of AI chatbot use, their suggestion that primary care physicians routinely screen for these issues adds yet another layer to an already unsustainable workload.
This isn’t a rejection of the importance of mental health, or even the potential harms of unchecked AI integration. It’s a recognition of a systemic problem. Primary care physicians are already inundated with screening requests. Domestic violence, human trafficking, food insecurity, elder abuse, and a litany of other social determinants of health – all undeniably significant – are routinely added to the list of “things doctors shoudl screen for.”
The reality is stark. Medicare’s annual wellness visit alone demands navigating eight additional pages of screening questions before addressing actual medical conditions like diabetes, hypertension, or heart failure.All of this is expected to be accomplished in a 20-minute appointment,assuming the patient doesn’t present with additional concerns.
this relentless expansion of responsibilities feels especially ironic coming from Silicon Valley. The prevailing ethos of “move fast and break things” seems to conveniently shift the burden of repair – the mental health fallout from rapidly deployed technologies – onto the very physicians already stretched thin.
Rather of continually adding to the checklist, shouldn’t the focus be on preventing the problems in the first place? Wouldn’t it be more effective for those developing these technologies to proactively address potential harms, rather than relying on primary care physicians to pick up the pieces?
I propose a simple counterpoint to the authors: as a psychiatrist deeply embedded in the Silicon Valley ecosystem, you are uniquely positioned to identify and address the chatbot creators contributing to mental health challenges. A minute or two of your time focused upstream could yield far greater benefits than another screening question added to an already overflowing patient intake form.
The solution isn’t more screening; it’s a basic shift in how we approach healthcare. We need to prioritize focused, effective care, and acknowledge the limits of what a single physician can realistically accomplish in a limited timeframe. True patient-centered care requires recognizing that sometimes, the most compassionate thing a doctor can do is to focus on doing fewer things, but doing them well.
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