Complex Patients' Effect On Family Physicians: High Cognitive Load And Negative Emotional Impact

Background and objectives: Complex patients present an increasing challenge to the health care system and family physicians play an important role in their care. As part of a larger project exploring family physicians' perceptions of complex patients, we sought to understand how complex patients affect family physicians and if these effects might be related to physician burnout.Methods: We conducted a qualitative study involving interviews with family physicians from various practice settings. We invited the physicians to choose three of their patients between the ages of 18 and 64 whom they considered to have complex medical problems and to have access to their medical records during a telephone interview using a semi-structured interview guide. Interviews were audio-recorded, professionally transcribed and coded. Using qualitative analytical software, research team members worked together to analyse the interview data and determine emerging themes.Results: Eleven family physicians participated in the interviews and described 29 unique complex patients, including challenges and effects on them personally. Analysis of the available 10 family physicians' interviews revealed two themes related to complexity's impact on physicians: (i) high cognitive load and (ii) negative emotional impact.Conclusion: Although preliminary, this study offers a previously unconsidered understanding of drivers of physician burnout, including high cognitive load and negative emotional impact on family physicians created by caring for complex patients. Interventions to improve health care, including addressing physician wellness and burnout, should include the provision of resources to assist them with decreasing cognitive load and negative emotional impact when caring for complex patients.Lay summaryComplex patients present an increasing challenge to the health care system and family physicians play an important role in their care. We interviewed family physicians from various practice settings, inviting them to choose complex patients between the ages of 18 and 64 from their practices and to have access to their medical records during the interview. We then analysed the interviews for recurring themes regarding the care of their complex patients. Ten family physicians described 26 unique complex patients, including challenges and effects on them personally. Two themes related to the complexity's impact on physicians emerged from our analysis: (i) high cognitive load (the total amount of mental effort required) and (ii) negative emotional impact. It is possible that these two effects of complex patients on family physicians may contribute to physician burnout. Interventions to improve health care, including addressing physician wellness and burnout, should include the provision of resources to assist them with decreasing their cognitive load and negative emotional impact when caring for complex patients.