Moral Injury in Health Care – Opinion

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It is not often that you can say that both war vets and doctors have the same injury from work. Not often, but that appears to be the case after a recently published study found that physicians suffer from “moral injury” at rates similar to those of combat veterans.

According to the U.S. Department of Veterans Affairs, moral injury refers to the distressing psychological, behavioral, social, and spiritual aftermath of exposure to highly stressful events that go against a person’s moral beliefs. It is often confused with posttraumatic stress disorder (PTSD). This term refers to military veterans caught in situations such as the need to kill despite the prohibition of the Sixth Commandment within the Judeo-Christian belief systems.

This type of mental anxiety is surprisingly becoming more common in the medical profession. This could be due to doctors losing their power in medicine. In the past, doctors worked together with patients to find mutually agreeable treatment. However, in today’s medical system, central control has so undermined the doctor-patient relationship that many physicians feel superfluous to care management and even must enact treatments that they do not agree with. Combined with this artificial constraint, obstacles to care, and productivity pressures placed upon them by governmental-insurance payers, physicians often feel disconnected from the rewarding care of patients.

Doctors feel disillusioned at the loss of their profession. They have spent many years training with hopes and dreams that this would lead to a noble career. A lot of caring physicians are now fighting against a system of health care that puts obstacles in their way of becoming a high-quality physician, rather than facilitating them.

A physician’s career was often multi-generational in the past. It was not unusual for physicians to say “My mom was a doctor,” or “My dad was a doctor and his dad was a doctor.” The love of the practice of medicine was passed down and inculcated through generations. This is a great reason. Being a physician means you are paid to take care of people. Isn’t that satisfying?

Over the last several decades however, things have changed. Now, the vast majority of physicians dissuade their children from following in their footsteps and physician suicide claims the equivalent of an entire medical school’s worth of physicians every year. Although caring for the sick or dying is not without its challenges, doctors have never given up on their careers and ended their lives as physicians.

Something has changed. It is the end of doctor-patient relationships through rushed paces, complete abdication of responsibility, and other problems that arise from the way we fund and manage the healthcare system. The doctor is responsible for the patients they treat. Yet, when they work for (or within) the insurance-governmental complex, the patient is degraded to the substrate through which the financial transaction occurs. It is both dehumanizing for the patient, and joy-depriving to the doctor who has been transformed into an inanimate data entry robot.

A new type of healthcare is being developed in the United States. Direct Primary Care is the name of this new type. DPC physicians are employed by their patients, and they receive a salary. Their attention is unaffected and they are free from the payer-induced conflicts that could infringe on the doctor’s autonomy. DPC providers are also less likely to have a large patient load. DPC providers are able to spend more time talking with their patients. This allows them to take a more relaxed approach, which allows for more understanding and thoroughness. For patients, this allows them to provide more personalized and humanistic care. Moreover, it is a healthier environment for the physicians who avoid the crush of non-stop 10-minute visits, which ultimately saps them of developing solid relationships with their patients.

The job of a physician is not easy. This is something that every doctor understands when they enter the medical profession. What most don’t know is the sole-crushing bureaucracy that works against their patients’ well-being, not to mention themselves. DPC is a way for physicians to return to their true role as healers. With the physician restored to their role as healer, being a doctor is something I can certainly encourage my children to do.

Chad Savage, M.D. ([email protected]) is a Heartland Institute policy adviser, Docs 4 Patient Care Foundation policy fellow, and the President of DPC Action.

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