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Physicians are said to grapple with their ‘moral injury’

An essay in STAT suggests that “moral injury,” not “burnout,” is the biggest problem for physicians now.

 The authors write:

“Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.

“Burnout is a constellation of symptoms that include exhaustion, cynicism, and decreased productivity. More than half of physicians report at least one of these. But the concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work”.

“The term ‘moral injury’ was first used to describe soldiers’ responses to their actions in war. It represents ‘perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.’ Journalist Diane Silver describes it as ‘a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”’

“The moral injury of healthcare is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of healthcare.”

To read the piece, please hit this link.

Physicians’ ways to avoid burnout


In this Physicians Practice thread, doctors talk about  the methods, some quirky,  that they use to avoid burnout in a time of healthcare upheaval.

To read their observations, please hit this link.

A cold look at expanding primary-care access



Terence Redmond McAllister, M.D., and Leann DiDomenico McAllister push back against the idea that primary-care practices should be available to patients all the time. This leads, they argue, to clinician burnout and doesn’t help patients in the long run either.

They write:

“According to the Institute of Medicine, America’s overuse of healthcare services costs nearly $300 billion a year. And while extended and weekend hours provide ‘convenience care’ to a demanding public, extended hours have been shown to encourage patients to run to the doctor for every minor symptom they experience. Our current healthcare system trains patients to ‘feel better fast’ by running to the nearest ER with an advertised short wait time, urgent-care clinic, or buy the newest over-the-counter snake oil remedy. Contrary to popular advertising, a typical cold lasts 7 days to 10 days. It’s time we teach our patients to self-sooth.”

“Rumor has it that our quality contracts and new ACO contracts will encourage our practice to stay open longer and provide weekend hours; to be available ‘whenever’ our patients want us. We believe extended hours will increase unnecessary care which will increase costs and lead to more physician burnout.”

“Does primary care really need to be totally accessible 365 days a year, with very early and very late hours? Won’t we all sleep better and lower our burnout rate if we help our patients lower their unrealistic expectations of being ‘picked up’ {like  babies} every time they cry out?”


Training physicians to avoid burnout


Some hospitals are training physicians to better manage their feelings in the face of what can be great stress on the job, as the problem of clinician burnout  (and the medical errors that may  sometimes be caused by it) seems to intensify.

As this Wall Street Journal story says:

“The increased focus on coping skills comes amid rising concern for the psychological health of physicians. A recent study found burnout rates among pediatrics residents at Seattle Children’s Hospital ranged from 41% to 77%, depending on the year of residency, says Maneesh Batra, who presented the findings at a recent meeting of the Pediatric Academic Societies. Dr. Batra, an associate professor of pediatrics at the University of Washington School of Medicine, says previous studies at other institutions have shown similar burnout rates among residents in other medical specialties. Research shows that higher doctor-burnout rates are associated with more medical errors, impacting patients.”


Rebuilding a sense of connection to fight burnout


Rebuilding a sense of connection is essential for hospitalists feeling burnout, suggested a couple of speakers  at the Society of Hospital Medicine’s 2016 annual meeting.

“Burnout is characterized in part by loss of connection to a sense of engagement or meaning in your work,” said Denah Joseph, from the University of California at San Francisco, who presented the strategies with her colleague Steven Pantilat, M.D., professor of clinical medicine and director of the palliative-care program.

“Taking time to reflect on what being a hospitalist means to you or practicing reflective writing can help you reconnect, Joseph explained, as can taking a moment for meditation to be aware of your surroundings and listen to the sounds of your breathing,” Medscape reported,

“Reconnecting doesn’t have to take time out of your day,  Ms. Joseph pointed out. It can be something you do while washing your hands between patients, for instance, or while walking your dog.”

Then there is “appreciative inquiry”: Asking a colleague to exchange ideas on what both of you find meaningful and positive about your work, Dr. Pantilat said.

He added that health systems can help by building provider stress reduction into systemwide goals. In fact, he reported, “there’s a system now looking at tying executive compensation to provider well being.”




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