In the winter of 2011, I walked away from fifteen years of training in surgery and psychiatry, working in both rural and urban emergency rooms, and as a private practice psychiatrist, to manage research funding for the U.S.
I believe that unless you are a sociopath, continuing to do something that violates your conscience will make you physically ill. If I had continued working in the U.S. healthcare system, I am sure I would have died years ago.
Aristotle asserted that a concept does not exist until it is named; in naming the condition it appears you have enabled others to speak more clearly of the inherent ethical conflicts--the moral injury--that can arise for care-givers, educators, etc. from working in environments driven by financial considerations. In retrospect I recognise this as well from having worked at a major US medical school where both ethical conflict and genuine burnout co-existed. Thank you for this contribution.
This is one of the primary reasons both my wife and I decided to retire from our professions (independently and at different times). She was an educator and still doing good things for her kids - making a difference. Increasingly, the system was blocking her from helping those kids and requiring things that were actually detrimental. She had to walk away.
In my case, as a hospital pharmacist, I too felt like I was contributing and making a difference. However, the system imposed an ever increasing workload where there was no room for error. Sooner or later a patient would be injured by an error. I had to walk away.
We were fortunate enough to have sufficient resources to retire. But we worry about those who are younger, struggling with those same issues, that can’t walk away. The effects of the accumulated moral injury will surely be very damaging.
Bill - I'm sorry for your experiences. I just wrote a piece for educators and I'm so clear about the impossible position many pharmacists are in right now. Your professions are poorer for your early retirements. I hope we can make change for younger generations.
They were not early retirements - we both were of age, so nothing really to be sorry for. The point was that it wasn’t burn out or wearing out, but being fed up. The systemic BS wasn’t just keeping us from doing right by the people in our care, it was forcing us to do wrong. The moral injury.
I have experience with diagnoses that I researched on Googled and found correct specialists . I self referred to 3 specialists their own academic oriented colleagues never suggested might have a better solution.. 3 orthoss all missed diagnosis for a benign tumor on sciatic nerve. S said Old Age Sciatica other said Baker's Cyst . At 55 the old age was insulting. I had to pay myself for tests to prove them wrong. Sleep doctor never referred to specialist for RLS New neuro recommended Patch to replace 8 pills a day that barely worked. No OB Gyn ever ordered Fibroidectomy til Medicaid required 2nd opinion and instead of total hysterectomy said 20 min outpatient Fibroidectomy Both Ob's were in same dept of same hospital. All incident involved university hospital physicians. A recorded note in my record alerted them to my bipolar. No therapist I ever saw for 20 yrs ever had a psychiatrist to confirm depression in winters. They never saw me til next winter Missed Spring Manis Never hospitalized for bipolar. MH diagnosis likely interferes with bad diagnoses. Classmate Doc I saw 30 yrs after grad told me we Both has bipolar 2 issues in College!!! Lately University corporatization is becoming more prominent. Blessed with scientific curiosity and internet I have managed to get care despite system defects. Financial takeover of systems impacting even non profit medical systems. " It's about the $$ Stupid!" applies now to Healthcare not just politics.
I have this gut feeling that "moral injury", although likely academically correct, fails as a potent descriptive term for what many physicians are experiencing. Furthermore I think the term "moral injury" is confusing and meaningless to most in society. Although I do not have a better terminology at hand I think finding terminology which the general public can relate too would be helpful if we want people to be supportive of the necessary change.
I have a gut feeling that you maybe didn’t really read the article. Did you not internalize the potency of her firsthand narrative of how many people instantly recognized the aptness of the term?? Dr. Dean and her colleagues didn’t make it up; she correctly recognized its applicability to our situation. It is apt because it correctly localizes the wound. Every single person I have shared this phrase with, including clinicians and patients and laypeople outside of healthcare, get it. There is no better term.
This is such an important "read," about a very important subject -- thank you. I deeply feel that the reckless and relentless pursuit of profit at the expense of morality (and humanity, compassion, integrity, and ethics) is a large part of what is destroying America "from within." This not just happening in healthcare; it permeates every aspect of our culture from food/consumer goods (inflation for profit) to entertainment (pandering to our baser interests), to communications (Twitter/X becoming a platform for White Nationalists; Google spying on Americans; Facebook creating dossiers for ad revenue, etc.).
Vulture capitalism is killing us all -- the only difference in the field of healthcare being that they are knowingly, willingly, executing us even faster. Depriving physicians of the ability to use all of their skills as expeditiously and humanely as they can, is indeed a deep moral injury -- and not just to healthcare providers themselves, but to the very soul of this nation. It is our Heart of Darkness.
I believe that unless you are a sociopath, continuing to do something that violates your conscience will make you physically ill. If I had continued working in the U.S. healthcare system, I am sure I would have died years ago.
This is a potential article. Thank you!
Aristotle asserted that a concept does not exist until it is named; in naming the condition it appears you have enabled others to speak more clearly of the inherent ethical conflicts--the moral injury--that can arise for care-givers, educators, etc. from working in environments driven by financial considerations. In retrospect I recognise this as well from having worked at a major US medical school where both ethical conflict and genuine burnout co-existed. Thank you for this contribution.
So true & I'm sorry you've experienced it, too. It's not either burnout or moral injury; it's BOTH. More detail: https://cdn.mdedge.com/files/s3fs-public/issues/articles/fdp04104104.pdf
This needs to be widely shared. I've linked to it in my post:
https://drmick.substack.com/p/first-do-no-harm
Thank you for spreading the word! More articles in the works . . . stay tuned.
This is one of the primary reasons both my wife and I decided to retire from our professions (independently and at different times). She was an educator and still doing good things for her kids - making a difference. Increasingly, the system was blocking her from helping those kids and requiring things that were actually detrimental. She had to walk away.
In my case, as a hospital pharmacist, I too felt like I was contributing and making a difference. However, the system imposed an ever increasing workload where there was no room for error. Sooner or later a patient would be injured by an error. I had to walk away.
We were fortunate enough to have sufficient resources to retire. But we worry about those who are younger, struggling with those same issues, that can’t walk away. The effects of the accumulated moral injury will surely be very damaging.
Bill - I'm sorry for your experiences. I just wrote a piece for educators and I'm so clear about the impossible position many pharmacists are in right now. Your professions are poorer for your early retirements. I hope we can make change for younger generations.
They were not early retirements - we both were of age, so nothing really to be sorry for. The point was that it wasn’t burn out or wearing out, but being fed up. The systemic BS wasn’t just keeping us from doing right by the people in our care, it was forcing us to do wrong. The moral injury.
I have experience with diagnoses that I researched on Googled and found correct specialists . I self referred to 3 specialists their own academic oriented colleagues never suggested might have a better solution.. 3 orthoss all missed diagnosis for a benign tumor on sciatic nerve. S said Old Age Sciatica other said Baker's Cyst . At 55 the old age was insulting. I had to pay myself for tests to prove them wrong. Sleep doctor never referred to specialist for RLS New neuro recommended Patch to replace 8 pills a day that barely worked. No OB Gyn ever ordered Fibroidectomy til Medicaid required 2nd opinion and instead of total hysterectomy said 20 min outpatient Fibroidectomy Both Ob's were in same dept of same hospital. All incident involved university hospital physicians. A recorded note in my record alerted them to my bipolar. No therapist I ever saw for 20 yrs ever had a psychiatrist to confirm depression in winters. They never saw me til next winter Missed Spring Manis Never hospitalized for bipolar. MH diagnosis likely interferes with bad diagnoses. Classmate Doc I saw 30 yrs after grad told me we Both has bipolar 2 issues in College!!! Lately University corporatization is becoming more prominent. Blessed with scientific curiosity and internet I have managed to get care despite system defects. Financial takeover of systems impacting even non profit medical systems. " It's about the $$ Stupid!" applies now to Healthcare not just politics.
ed
It is impossible to understand cruelty.
I have this gut feeling that "moral injury", although likely academically correct, fails as a potent descriptive term for what many physicians are experiencing. Furthermore I think the term "moral injury" is confusing and meaningless to most in society. Although I do not have a better terminology at hand I think finding terminology which the general public can relate too would be helpful if we want people to be supportive of the necessary change.
It’s a term that has been widely used in the PTSD literature and conversation. You’d like to propose a better term? Go for it!
I have a gut feeling that you maybe didn’t really read the article. Did you not internalize the potency of her firsthand narrative of how many people instantly recognized the aptness of the term?? Dr. Dean and her colleagues didn’t make it up; she correctly recognized its applicability to our situation. It is apt because it correctly localizes the wound. Every single person I have shared this phrase with, including clinicians and patients and laypeople outside of healthcare, get it. There is no better term.
This is such an important "read," about a very important subject -- thank you. I deeply feel that the reckless and relentless pursuit of profit at the expense of morality (and humanity, compassion, integrity, and ethics) is a large part of what is destroying America "from within." This not just happening in healthcare; it permeates every aspect of our culture from food/consumer goods (inflation for profit) to entertainment (pandering to our baser interests), to communications (Twitter/X becoming a platform for White Nationalists; Google spying on Americans; Facebook creating dossiers for ad revenue, etc.).
Vulture capitalism is killing us all -- the only difference in the field of healthcare being that they are knowingly, willingly, executing us even faster. Depriving physicians of the ability to use all of their skills as expeditiously and humanely as they can, is indeed a deep moral injury -- and not just to healthcare providers themselves, but to the very soul of this nation. It is our Heart of Darkness.