Not 'Burnout,' Not Moral Injury--Human Rights Violations

Pamela L. Wible, MD

Disclosures

March 20, 2019

In This Article

What's Wrong With Physician Work Hours?

Physician work hours are far out of compliance with labor laws deemed safe in other industries. Companies in Japan face criminal sanctions for suicides (and non-suicide deaths) if employees work more than 60 hours/week, yet our doctors work 80, 100, even 120-hour weeks (trainees are forced to lie on work logs to comply with the "80-hour cap"). Extreme sleep deprivation leads to hallucinations, life-threatening seizures, and post-shift fatal car accidents (plus medical errors). Human rights abuse includes sexual harassment, racism, food/water deprivation, hazing, bullying, pimping, even physical assault—trainees have been hit with knives, punched, and left crying in operating rooms and hospital hallways.

The solution for labor law violations is compliance, for sleep deprivation is a bed and pillow, for food/water deprivation is regular meals, and I'm sure we all agree there's no place for discrimination and violence inside our hospitals. Understaffing cannot be solved by continuing to force new residents to work beyond their physiologic capacity for minimum wage.

Naturally, medical institutions would rather celebrate their new chief wellness officer and meditation garden than take responsibility for these human rights violations against their own physicians and trainees. Denial and avoidance only perpetuate abuse, leading to more suicides.

I'm a systems thinker, a scientist, a doctor. My job is to prevent human suffering and death—even when inflicted by institutional violence against physicians inside our own hospitals.

In medicine, combating illness requires primary, secondary, and tertiary prevention. Primary prevention intervenes before injury (seatbelts). Secondary prevention reduces impact of established illness (antidepressants). Tertiary prevention improves quality of life in those with chronic illness (PTSD support groups).

Primary prevention to prevent human rights violations against physicians includes unionizing, class-action lawsuits, wrongful death litigation, strikes, walkouts, boycotts, peer leader negotiation with administrations, hospital fines, and loss of accreditation. Secondary prevention includes psychiatric care, counseling, modified/part-time work schedules, leaving toxic employers, and launching your own practice. Tertiary strategies are whistleblowing by speaking up and writing articles detailing abuse, support groups, retreats, and self-care.

Solving our crisis requires a definitive diagnosis and treatment plan. Now is the time for brutal truth—and action.

Moral injury may be less abrasive and more academically and politically acceptable than human rights violations. Should we choose a diagnosis based on what's socially acceptable?

Imagine if we say "heart injury" rather than myocardial infarction or ruptured aorta. If we don't name the definitive diagnosis, how do we progress to appropriate labs, tests, and interventions? If we fear the truth and waver on the assessment, patients will die from our indecisiveness.

Let's not waver on the truth.

We're in the midst of a medical system emergency that can't be solved on an individual level with tertiary prevention strategies. Emergencies require immediate action—airway, breathing, and circulation, not yoga and Zen meditation.

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