Regarding last week's question on burnout in the medical professions:

Hospital administrators pat themselves on the back when they announce physician wellness plans claiming they want to reduce burnout.These plans most often focus on mindfulness and recommendations to exercise or sleep more.These programs are designed by well-meaning people but unfortunately they are not reducing burnout. A radical change is needed. Instead of focusing on physician resilience, we need to decrease the tsunami of clerical work that now represents much of the work we do. Instead of looking into our patient’s eyes when they are speaking, we are expected to feed the electronic medical record monster during office visits and update dashboards that have little clinical value. Many physicians are also now required to be responsible for health messaging systems 24 hours a day. That demand runs contrary to any sense of wellness.

 — Allan Mishra, Menlo Park, Calif.

Personally, the most disappointing trend that I have seen is the decline of respect shown to myself or my colleagues. More and more patients feel free to make degrading comments on their doctor visits online, but rarely tell the full story. Fortunately for them, HIPAA regulations prevent us from commenting with the medical facts of why we make decisions that they may not agree with but are in the best interests of their health. We also can't post how many visits they miss, show up late for or when they fail to follow pre or post-operative instructions. If only patients could understand the years of education, training and continual updating of ever increasing medical advances (not to mention huge student loan debt) that we endure to care for them, we might not be reduced to a two-line random Yelp or Google review because we wouldn't give an inappropriate antibiotic or pain prescription. — Mark D. Zajkowski, Cape Elizabeth, Maine

If I had one suggestion, it is that junior people need to have more senior colleagues that can help mentor them through the complexities of career/family/life who are not in a position to reward/punish, and are ultimately safe to be able to talk to without fear of showing weakness. — Alan Zunamon, Glenview, Ill.

There is a reason that the younger and older doctors cite different causes contributing to stress and burnout. As an interventional cardiologist I lived the stress of a demanding hospital and clinic practice. However as prior chief of staff at our largest hospital, and the chief medical information and innovation officer who forced the electronic health record upon them, I learned of physicians' dissatisfaction unrelated to the actual practice of medicine. The differences are related to the age in which the individuals entered the profession, and the changes in professional culture and the health-care delivery system that occurred since I went into practice.

 — H. Elizabeth Noll, San Diego