We commonly hear that healthcare practitioners are “burning out.” I’ve been describing the problem not as burnout as much as abuse by their bosses. A more accurate recent characterization is “moral injury.”
Here’s an example. I once sat in on a meeting between an internist and her patient, a young woman crying in pain from advanced rheumatoid arthritis. The doc told me later that her patient’s misery saddened her such that she just wanted to hold her. But she caught herself, regained her composure, and wrote her a painkiller prescription.
When I’d been in similar situations, two competing instructions ran through my head. One: whatever it takes, comfort the patient. And two: abbreviate the meeting since other patients are waiting, along with paperwork and inevitable arguments with insurance people.
The term “moral injury” first bubbled up in the 1990s, as a description of what people suffer when compelled to act contrary to their values. It’s a common precursor of post-traumatic stress disorder, especially within the military. With extended repetition, we perceive our own moral injury less acutely, and discomfort gradually fades from the foreground. In fact, this helps account for much of humanity’s most awful behavior.
The nature of medical practice has changed during my lifetime in a way that minimizes compassion. In the old days, docs’ independence allowed time to behave therapeutically. Today, though, almost all docs work for businesses, contracted to move patients along since compassion minutes aren’t billable: write the scrip and proceed to the next room or you’ll get a note from the HR department.
Commercial domination of healthcare damages both parties. The patient is likely to leave unfulfilled and even angry. And the practitioner suffers laceration of the soul.
Though it can’t be physically detected, moral injury steadily festers, emerging finally as depression and self-destructive behavior, disorders notoriously endemic in healthcare as well as the military. Each year about 400 American doctors commit suicide--roughly the loss of an entire medical school.
There’s abundant evidence of moral injury’s source. A survey published by Business Wire disclosed that 89% of queried doctors insisted that the best care was informed by compassion. Docs ranked compassion even higher than command of medical knowledge. Almost all the doctor respondents stated that compassion makes patients more likely to follow their advice, thus improving outcomes.
Patients agree. In the same survey, 86% of a large group of patients cited compassion as healthcare’s most important quality. They ranked it higher than wait time and even higher than cost, which only 31% cited as most important.
Since it’s more widely known now that both docs and patients prize compassion, its revival seems to be gaining traction. In several centers doctors are beginning to unionize, aiming to preserve their souls along with their jobs. Whether conscious of it or not, they’re following Mahatma Gandhi’s advice: “Never do the wrong thing, even if the authorities require it; always do the right thing, even if the authorities forbid it.”
