In the wake of a pandemic, there has been a great deal of focus on physician burnout. Is it possible that we aren’t looking at the problem and solutions in the right way? Quality Reviews co-founder and CEO Edward Shin, MD gets to the heart of the issue with Dr. Wendy Dean, a physician and the co-founder of The Moral Injury of Healthcare, a 501(c)(3) non-profit working to improve the lives of physicians.
Who do we blame: the system or the physician?
What is moral injury, anyway? Often physicians feel like their hands are tied, and like they don’t have the control that they need to properly perform their duties. Not only that, but Dean says that they operate on an assembly line model. These models don’t work in the case of an emergency.
Furthermore, Dean expresses that most conversations around fixing burnout put the onus on the individual. By renaming and reframing the problem as moral injury, we put the onus back on the system, where it belongs.
The pandemic may have exacerbated moral injury, but it certainly did not create the problem. Dean has been bringing attention to it for years. In 2018, she even co-wrote a Stat News op-ed that compared a physician’s role to a combat soldier. As someone who’d worked directly with military doctors, she was able to articulate how moral injury can impact both roles. The veteran goes on to develop PTSD, and the physician burns out. Both hold jobs that lead to similar plights because of what’s expected of them. Both are considered heroes, on top of their extremely important roles that are held to higher standards than other members of society. Another parallel is the high suicide rate for veterans and for physicians.
Those who are in the position to affect change have to ask themselves why their solutions aren’t working. Do they have an accurate grasp of what’s happening?
“I love what I do, what I can’t stand is everything around it.”
According to Dean, “Clinicians are held to a higher standard than other members of society. We don’t let them just be human. We need to offer solutions based on who they are.”
She adds that meaningful communication is important, and doctors are more isolated from socialization than they used to be, which is likely due to scheduling and structure. They are also tired, which certainly impacts motivation. Medical culture needs to change, but other changes need to be made in order for that to happen.
How Do We Begin to Fix Moral Injury?
First things first, we need to recognize that doctors are human.
Dean believes that we’re taking humanity out of medicine and telling physicians to be more compassionate. One suggestion she offers is giving doctors scribes, some sort of third party that can transcribe and enter in the requisite data into the electronic medical record (EMR). That would allow doctors to be human with their patients again, rather than being mired in the computer data-entry that is required by today’s EMR.
She also recommends redesigning the EMR around the doctors’ needs, a practice that many healthcare facilities have gotten away from in recent years. That includes eliminating as much as 90% of criteria and metrics that are required during appointments. “We really need to streamline the data.” She believes that changes to those record systems alone can reduce the moral injury that physicians face.
Dr. Dean also suggests these government fixes:
- Requiring any hospital that takes CMS funds to have physician well being on their scorecard.
- Addressing faults in insurance, such as preauthorization requirements
- Last but not least, EMR practices need to be revamped
Dr. Dean believes that hospital systems and government officials should make doctor’s needs a priority in order to reduce burnout. The difference can mean protecting one of the most important professions in history, which will in turn impact our collective future.