While burnout has become a common phrase in healthcare, clinicians are increasingly using “moral injury” to describe the day-to-day challenges of working in healthcare.
“I think it’s on the continuum,” Michael Anderson, MD, a pediatrician and co-executive director of WittKiefer’s Physician Leadership Institute, told Becker’s. “I think there’s mild burnout, there’s significant burnout and then there’s, ‘Oh my gosh, I can’t practice what I want to practice because of some sort of obstacle or some sort of burden.’ As I looked more in the definitions, burnout is that feeling of tiredness or frustration or what have you. But to me, moral injury is the inability of a physician to truly care for his or her patient. And obviously, the long-term consequence of that moral injury can be really significant.”
Two physicians recently joined Becker’s to discuss their experience with moral injury and how they think it can be remedied within the healthcare system.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Have you ever experienced moral injury? What do you think must change about healthcare to avoid moral injury for physicians?
Craig Bailey, MD. Internal Medicine Physician with The Bailey Medical Group (Detroit): Moral injury is distinct from burnout. Burnout says “I’m exhausted,” while moral injury says “I know what this patient needs and I’m structurally prevented from providing it.” The fix isn’t more physician resilience; physicians are already resilient, and telling them to be more so is its own small insult. What has to change is structural: Physicians need to recover the authority that matches their responsibility, which takes both sovereignty, owning the tools, data, and infrastructure that let you act on judgment without asking permission, and collective power. Those aren’t in tension; sovereignty is what makes solidarity credible, because physicians can stand together far more effectively when each of them can also stand alone.
Evan Weiner, MD. Emergency Medicine Physician (Philadelphia): Yes, every day. I’m a hospital-based physician in emergency medicine. It is made known every day how profits are chosen over patients. The staffing schedule keeps getting cut, making patient care harder on the docs still working a shift. These cuts are always framed as efficiency and cost savings, not about better care for kids (I do pediatric ER). The hospitals know that the ground level docs will work extra hard to make sure cuts don’t reach the patient due to our Hippocratic oath and love of the patient. The administrators solely focus on the budgets and dollars. It leads to physician burnout because it’s not about care of human factors, which include care of the staff (caregivers) and care of the patient. So a lot of administration talk about having patient care be the highest priority is lip service because we see the cuts every day to that care. For this to change, the priority truly has to be the patient and not the dollar. Hospitals need to act as the not-for-profits (i.e charities) that their designation denotes. And insurance companies have to be care facilitators not blockers. The mission has been totally lost.
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