Jefferson Surgical Solutions

Charles J. Yeo, MD, FACS, Samuel D. Gross Professor and Chairman, Department of Surgery, and Senior Vice President and Chair, Enterprise Surgery Jefferson Health

Much has been written about health care worker (HCW) burnout – defined as a constellation of symptoms which include exhaustion, cynicism and decreased productivity; it has been clearly linked to increased rates of depression, suicide and departure from health care employment. Surveys show that large percentages of HCWs report burnout. We have all read the various studies.

But Talbot and Dean* suggest a different perspective – they opine that the concept of burnout resonates poorly with many HCWs, as it suggests a failure of resilience, grit and resourcefulness (traits present in most HCWs; learned and practiced through long training and demanding work). They posit that burnout is itself a symptom of a larger issue – our inefficient health care system, where HCWs navigate a complex web of conflicted allegiances (patients, self, employers, insurers, third parties, etc.) – resulting in moral injury. The term moral injury originates in the language of war, and was used to describe soldiers’ personal responses to their actions in war – codified by journalist Diane Silver as “a deep soul wound that pierces a person’s identity, sense of morality and relationship to society.” Such a definition resonates with me, as I discuss weekly the challenges we face as HCWs with staff, faculty, trainees and students.

The moral injury of health care is not the offense of killing another human being in the context of war – rather it is being unable to consistently and without excessive burden provide high quality care, preventative health and healing in the context of contemporary U.S. health care.

There is accumulating evidence that progress on this topic in the context of HCWs requires more than employee surveys, wellness programs, teaching mindfulness and meditation, and minor adjustments to schedules and scheduling templates. HCWs deserve leaders (on the national, state and local scene) that acknowledge the human costs and moral injury that stem from a health care system that is challenged with excessive regulation, fails to provide for all citizens and is fraught with multiple competing allegiances. HCWs are a critically valuable commodity for our industrialized society, and they should be treated with respect, allowed autonomy and encouraged to make rational, safe and evidence-based decisions in the best interest of patients. I am optimistic that time and intelligent reform will create a future win-win scenario, where the wellness of our patients is linked to the wellness of all providers.

*Suggested reading – Talbot SG and Dean W. “Physicians aren’t ‘burning out’. They are suffering from moral injury.” July 26, 2018. STAT.