When we began exploring the concept of moral injury to explain the deep distress that U.S. health care professionals feel today, it was something of a thought experiment aimed at erasing the preconceived notions of what was driving the disillusionment of so many of our colleagues in a field they had worked so hard to join.

Dr. Wendy Dean co-authored this peer-reviewed paper with Dr. Breanne Jacobs and Dr. Rita Manfredi.

Physicians took two hard hits in May 2019. The first: the WHO will include a more detailed description of burnout as an occupational phenomenon in the International Classification of Diseases-11. The second: physician burnout costs the healthcare system $4.6 billion each year.

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament? Dr. Dean explores these questions in the latest piece for Medscape entitled: COVID-19 Is Making Moral Injury to Physicians Much Worse.

I watched, horror-stricken and helpless, as my husband tried very hard to die.

He was not yet 50, but during one desperate winter night in a small hospital’s intensive care unit, I held his hand as, in staccato bursts between gasps of breath, he planned his funeral, grieved for the future he would not see with our two young boys, and implored me to remarry.

Moral injury occurs when the basic elements of the medical profession are eroded, say Simon G Talbot and Wendy Dean. But how to avoid moral injury in physicians?

In July 2018, the physicians wrote an article that reframed clinician distress as moral injury, rather than burnout. In our view, “burnout” suggests a lack of resilience on the part of clinicians, implying that better self-care will resolve our distress, whereas “moral injury” more accurately locates the source of distress in a conflict ridden healthcare system.

At a recent national meeting of perioperative nurses, more than 80% of audience respondents who reported feeling distressed endorsed the term “moral injury,” rather than “burnout,” in an informal poll. No segment of healthcare has a corner on distress. We are all suffering. We must Team Up to Fight Moral Injury!

For more than a decade, the term burnout has been used to describe clinician distress. Although some clinicians in federal health care systems may be protected from some of the drivers of burnout, other federal practitioners suffer from rule-driven health care practices and distant, top-down administration. Reframing Clinician Distress: Moral Injury Not Burnout – our thoughts in the link below.

When the patient is a consumer there is a shift in the implied power dynamic. Rather than presenting to the physician seeking his or her expert advice and counsel, the interaction becomes a transactional one in which the physician provides a service and the patient pays for it. In this type of dynamic, the patient-customer is “never wrong,” according to Cesar Ritz’s well-known edict, broadly adopted in the hospitality industry.

Could burnout and anti-burnout initiatives championed by healthcare institutions be the healthcare equivalent of gaslighting?

Our words matter. As with making an accurate diagnosis, using accurate language to describe a situation is the necessary first step in describing its resolution.

The concept of moral injury expresses the systemic nature of the strain on physicians and the need for a comprehensive approach to address the problem.

Wendy Dean, MD and Simon Talbot, MD address the challenges facing medical students as they learn the brass tacks of medicine as well as navigate the complicated world of healthcare.