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Are Medical Practitioners Really Suffering from Moral Injury?

In an effort to shift the culpability from the results of toxic drugs away from those who continually prescribed and administered them in the first place, a carefully written article was published in STATNews titled “Physicians aren’t ‘burning out.’ They’re suffering from moral injury”, with citations from RAND’s “objective analysis” on “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.”

An innocuous phrase has just been reassigned to shift the blame away from the professional marketers and prescribers of toxic chemicals within what they called as the healthcare system, and into the long stonewalled business aspect of it.

They are now telling us that they too are suffering from a “moral injury” by not being able to provide” high-quality care and healing in the context of health care,” saying that “most physicians enter medicine following a calling rather than a career path.”

They recognize the failure to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury. What is the root cause of this consistent failure to meet patients’ expectations is said to be the conflicts of interest between the financial considerations of hospitals, insurers and the physician himself.

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.

That article written by a medical practitioner is very revealing of the mindset that most medical doctors today have to contend with. There simply is no strong motivation to cure the sick for good from their end, or from the system itself.

“Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.

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.”

Yet, even when they are morally injured, they cannot present a more viable alternative. But they are smart just the same.

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.

In conclusion, the same article is forwarding possible solutions to the problem of low quality healthcare with:

  • What we need is leadership willing to acknowledge the human costs and moral injury of multiple competing allegiances. We need leadership that has the courage to confront and minimize those competing demands. Physicians must be treated with respect, autonomy, and the authority to make rational, safe, evidence-based, and financially responsible decisions. Top-down authoritarian mandates on medical practice are degrading and ultimately ineffective.
  • We need leaders who recognize that caring for their physicians results in thoughtful, compassionate care for patients, which ultimately is good business. Senior doctors whose knowledge and skills transcend the next business cycle should be treated with loyalty and not as a replaceable, depreciating asset.
  • We also need patients to ask what is best for their care and then to demand that their insurer or hospital or health care system provide it — the digital mammogram, the experienced surgeon, the timely transfer, the visit without the distraction of the electronic health record — without the best interest of the business entity (insurer, hospital, health care system, or physician) overriding what is best for the patient.
  • A truly free market of insurers and providers, one without financial obligations being pushed to providers, would allow for self-regulation and patient-driven care. These goals should be aimed at creating a win-win where the wellness of patients correlates with the wellness of providers. In this way we can avoid the ongoing moral injury associated with the business of health care. – Simon G. Talbot, M.D., is a reconstructive plastic surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School. Wendy Dean, M.D., is a psychiatrist, vice president of business development, and senior medical officer at the Henry M. Jackson Foundation for the Advancement of Military Medicine.

This is the mindset of those whom we entrust our physical survival with. They scholarly write articles which identify the problem in details, yet purposely distract us from the real solution with more of the same myopic measures that have nothing to do with real public health care whatsoever.

The chemical, invasive and radioactive methods would still be there, because those things ensures the win-win scenario for the doctors and business, and to hell with their common clientele. However they justify their use, toxic chemicals can never be part of an honest healthcare system.

Therefore, the so called physician’s “moral injury” is self-inflected, and a better share and command of the pie won’t help eliminate the public scorn towards the medical practice in general.

They must have a better set of morals first, because sending a child to an expensive school out of the fat incentives that Big Pharma provides as a consequence of the willful, “smart, tough, durable, resourceful” prescription of toxic vaccination of other people’s children, is not a moral injury at all, but plain hypocrisy and greed.

In the end, we can only agree on one thing, i.e. they aptly use the same phrase that is applicable to war veterans who are now suffering from mental anguish after realizing that they have decimated the wrong enemy.

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