Page 9 - Delaware Medical Journal - September/October 2018
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PRESIDENT’S PAGE
RICHARD W. HENDERSON, MD
MSD President Richard W. Henderson, MD is an Obstetrician and Gynecologist who practices at Saint Francis Healthcare.
Moral Injury
In my Inaugural Address last December, physician burnout was one of the issues I highlighted as being important to
address if Delaware, and the nation, are to have a healthy physician workforce. Tina Irgang Leaderman’s article in the July/ August edition of the Delaware Medical Journal adds to the increasing literature about this important issue.
described in early 1970s. Physical and emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment have been well documented as the three major symptoms and signs associated with this condition. As noted in Ms. Leaderman’s article, there are also now well-recognized opportunities to address this critically important issue. This discussion continues to evolve, as does the language used to describe it.
An opinion piece on the subject of physician burnout that was written by two physicians and published in the Boston Globe on August 5, 2018 was recently shared with me. The title is “Physicians aren’t ‘burning out.’ They’re suffering moral injury.” It resonated with me immediately as I thought of friends and colleagues who had “burned out.”
A Wikipedia search of the term “moral injury” describes it as “a normal human response to an abnormal event.” The authors of the article point out that this
term is used to describe the responses
of soldiers who have witnessed
or perpetrated acts in combat that transgressed deeply held moral beliefs and expectations.
So, how does this translate to physicians and the issue of burnout? When this concept is applied to physicians in the often used metaphor of entering battle against sickness in disease, the authors argue that, “The moral injury of healthcare is not the offense of killing another human being in the context of war. It is being unable to provide high- quality care and healing in the context of healthcare.”
As a cause for this injury, the authors point to “an increasingly business- environment in which physicians must consider a multitude of factors other than the patient’s best interest when deciding on treatment.” The factors they identify are ones we’re all familiar with and face electronic health records that reduce time spent with patients and on patient care, as well as the ever-present fear of medical liability that leads us to “over-test, over-read, and overreact to results — at times actively harming patients to avoid lawsuits.”
The authors go on to say that “Navigating an ethical path among such intensely
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