Physicians and “Moral Injury”

A recent article by Simon Talbot and Wendy Dean spoke volumes to us here at Still Point. The article, titled “Physicians Aren’t Burning Out …” takes the idea of “burnout” and replaces it with the concept of physicians suffering “moral injury.”

What this means, the authors argue, is the inherent chasm between, on one side, the expectations and desires of physicians to care for their patients — and, on the other side, the depressingly heavy weight of things that get in the way. These things include insurance companies, the model of corporate medicine, Medicare, coding, EMRs, computers in the consult room … basically everything that stands between the physician and the care she or he has for the patient.

Talbot and Dean levy the cause of this moral injury squarely at “our broken health care system” and, within it, the inability of the physician to “provide high-quality care and healing.”

There’s too much getting in the way.  The corporate mindset, with its attendant emphasis on gobbledegook-like bizspeak, such as appointing employees to act as fungineers in a somewhat sad attempt to artificially construct fun in the workplace, lays a destructive patina over the core of the problem. And, within that model, the core is buried under ever-growing layers of alleged efficiencies and streamlining that only serve to compound the problem.

One such example is the EMR, or Electronic Medical Record, a computer-based system that brings healthcare down to the level of fill-in-the-dots with a thousand mouse-clicks. Although, in the words of Talbot and Dean, the EMRs “are extraordinarily effective at tracking productivity [mouse clicks?] and other business metrics, [they] overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions.”

Exactly. And this leads to immense frustration. Physicians are trained to evaluate, assess, treat, and respond to patients. They are not data entry clerks. Nor are they wanting to dance the salsa down the corridor in a sad-and-sorry corporate attempt to infuse fun in the workplace. Quite simply, most physicians want to look after their patients. And, within the current “broken system” of healthcare in this country, they are “[r]outinely experiencing” the “deeply painful” feelings of “suffering, anguish, and loss” when they are “unable [within that system] to deliver the care that patients need.”

Yes, as the authors point out, physicians are “smart, tough, durable, resourceful people.” And, yes: there are many who have contemplated leaving health care. Not all, however, stay “wounded, disengaged, and increasingly hopeless.” Some, as we have done with Still Point Medical, take the initiative — and the lead — by working hard to create something different, which we believe we have done with the hybrid Direct Care Practice that is Still Point.

Talbot and Dean are quite right. We do not need a “Code Lavender” team to dispense “‘information on preventive and ongoing support'” nor to hand out “‘aromatherapy inhalers, healthy snacks, and water'” in response to crises.  That goes along with the fungineers and other corporate-world travesties. Such measures will not “change the institutional patterns” of our contemporary health care model that “inflict moral injuries” on physicians and patients alike.

We do not need one eye on the balance sheet and the other on the next business cycle, nor must we turn our physicians into data entry clerks, nor do we need the flotilla of coders to turn the practice of medicine into an ever-convoluted system of bean counting or evaluations that chide practitioners for “leaving money on the table” — or those same evaluations delivered with a snide sideways glance at how valued is the practice of “gaming the system” from within its own indefensible constructs. All of this is abhorrent to the honored and honorable practice of medicine.

We met with our CPA the other day. Still Point is a year old and we needed to check our income in relation to having paid the proper amount of taxes. Our projected income is nowhere near what it could have been had Still Point been a corporate medical entity. In fact, it’s probably less than 10 percent. The satisfaction, though, of really touching our patients’ lives, along with a smaller number of patients with whom we can really interact and know, matters to us. Visiting, this past Sunday, one of our patients who had been admitted to hospital is what matters to us. Calling to see how our patients are doing with no other reason than because we were thinking about them is what matters to us.

And it matters to our patients, too.

A medical practice that works away from the concept of “moral injury” is one, the authors assert, “where the wellness of patients correlates with the wellness of providers” and where the best interest of the patient — not the insurance company, hospital, Medicare, medical group, or fungineering supervisor — is what the physician is best interested in.

PHYSICIAN BURNOUT

Physician Burnout: A “Moral Injury”

 Aarón Blanco Tejedor

  1 comment for “Physicians and “Moral Injury”

  1. September 18, 2018 at 8:20 pm

    We are so delighted you have chosen to remain in medicine, and have found a way to do so. This is medicine at its best: a healing art that has its foundational basis in mutual trust. The comfort of knowing that we have a physician like you is incalculable. No insurance could ever offer us the sense of security that we gain simply from knowing that you are our physician and we are your patients. Thank you.

    Liked by 1 person

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