How Healthcare Is Causing 'Moral Injury' to Doctors


March 13, 2019

In This Article

Pressured Into Situations That Violate Their Beliefs

Being a physician is not like any other job.

Doctors witness suffering among people they've come to care for. They're intimately involved in decisions involving life and death, pain and suffering, and quality of life. Many of the situations they face involve wrenching, frustrating ethical quandaries.

At the same time, physicians are overworked, pressured with productivity targets, and stymied by regulations and rules. Today's healthcare system often prevents physicians from being able to deliver the care that they feel is right and best for the patient.

The impact of dealing with feelings of dismay and helplessness over not being able to "just be a doctor," and the inability to resolve frustrating ethical dilemmas in a positive way, assault a person's emotions and psyche.

Some have called it a "moral injury" that is being inflicted upon physicians.

"Working in healthcare is not like working at Google or some other corporation," says Carol Bernstein, MD, a psychiatrist at New York University's Langone Medical Center. "Physicians are dealing with people who are really frightened and scared. You're trying to help them, trying to make them better. That's why many doctors think of this profession as a higher calling."

"Physicians talk about the corporatization of medicine, with the imposition of all the guidelines and regulations," says Bernstein. "It makes doctors less able to deliver the care they want to deliver, which contributes to burnout and stress, which harms physicians and their relationships."

Moral Instead of Physical Injury

The concept of moral injury arose in relation to military situations, in which soldiers in time of war were required to participate in situations that violated their own moral and ethical codes. Jonathan Shay, MD, PhD, psychiatrist in Colrain, Massachusetts, described a form of moral injury that occurred when service members were forced to do something that violated their own ideals, ethics, or attachments.[1]

Soldiers could experience the moral injury effect simply from witnessing or learning about acts that breached their own moral beliefs and expectations, according to Michael D. Matthews, PhD, professor of engineering psychology at the US Military Academy in the Department of Behavioral Sciences and Leadership.[2]


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