“Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.
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. Even at the Mayo Clinic, which has been tracking, investigating, and addressing burnout for more than a decade, one-third of physicians report its symptoms …
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 health care 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 health care.
Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.
In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits …
Navigating an ethical path among such intensely competing drivers is emotionally and morally exhausting. Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.
Physicians are smart, tough, durable, resourceful people. If there was a way to MacGyver themselves out of this situation by working harder, smarter, or differently, they would have done it already. Many physicians contemplate leaving heath care altogether, but most do not for a variety of reasons: little cross-training for alternative careers, debt, and a commitment to their calling. And so they stay — wounded, disengaged, and increasingly hopeless.”
The foregoing excerpts from “Physicians aren’t ‘burning out.’ They’re suffering from moral injury” by Simon G. Talbot, MD, and Wendy Smith, MD, in the July 26, 2018, edition of Stat (https://bit.ly/2JYAqX7) describe a situation that isn’t resolvable without the rebalancing of healthcare delivery with healthcare financing and other non-clinical issues. While healthcare provider leadership leadership is a necessary mitigating factor, so also is the provision of tools to make humanly possible the compete, accurate and timely practice of medicine in an increasingly more complex and time-critical work environment that creates cognitive overload among healthcare provider subject matter experts (SMEs), both administrative and clinical. The Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS)© will enable healthcare provider SMEs to design, develop, deploy, operate and optimize mobile apps that create customized cognitive support with real-time features such as automated process flow, constant monitoring, automatic notification, similarity and predictive analytics and clinical decision support.
Please validate this proposition to your own satisfaction by reading the white paper; or by viewing a presentation.that describes the background, purpose and scope of CHARTSaaS©; or by viewing a presentation that describes how SMEs can use CHARTSaaS© to create a mobile app for handoff communication mistake mitigation. CHARTSaaS©-built apps can mitigate medical mistakes (currently the third leading cause of patient deaths in the USA, per Makary and Daniel); thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment and also accelerating the accrual and facilitating the application of medical knowledge. Please contact me, Pete Melrose, at jpetermelrose@gmail.com or +1 (612) 201-2301 to discuss and decide re how you or your organization can participate in development completion and launch of CHARTSaaS©. Patient lives may depend on your decision. Thanks for your consideration and hopefully your support, and good wishes for another great day!