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LMS President’s Message: July 2023

LMS President’s Message: Moral Injury Physicians
By Lee Dossett, MD

If you are active in the physician community on Twitter, there is a good chance that you saw commentary on a recent article that was published last week by The New York Times Magazine titled “The Moral Crisis of America’s Doctors”.  Many providers retweeted the article, often adding comments in support of its representation of what being an American physician in 2023 looks like.  The article focuses on the concept of “moral injury”, which refers to the profound psychological and emotional distress experienced by workers when their core moral values are compromised or violated. It sheds light on the challenges we face today and calls for a moment of reflection on the future of medicine.

The article explores the evolving landscape of healthcare, with a particular focus on the increasing commercialization and bureaucratic burden that physicians experience. It highlights the mounting pressures doctors face, such as the rise of electronic health records, demanding documentation requirements, and the encroachment of profit-driven interests on patient care. These factors can erode the core values that brought us into medicine in the first place, leaving many doctors grappling with moral injury.  One quote from a physician stood out to me: “Doctors are increasingly the scapegoats of systemic problems within the health care system…” because the doctors are the interface point.  Insurance companies are faceless, but you sit across from your doctor.  If you have ever had a prior authorization denied or have a patient tell you about an exorbitant bill, you probably felt responsible to some degree and that is when moral injury occurs.

Government policy incentivizes consolidation of health systems and the large-scale employment of doctors.  Private equity funds buy large practices while cutting costs and pushing productivity, further increasing burnout.  In this setting, physicians have less time and mental energy to take the best care of patients.  You may be rushed to see a full waiting room and not be able to spend the few extra minutes getting a history. Instead, we order more tests, more imaging, and more consults, all of which reduces value for the patient. 

The U.S. needs to address the systemic issues that contribute to the moral crisis among doctors. Healthcare policies should prioritize the well-being of both patients and physicians, fostering an environment that encourages ethical decision-making and professional fulfillment. It is essential to reduce administrative burdens and streamline processes so that doctors can focus on what truly matters—the health and welfare of their patients.  Much of the work of organized medicine, such as the KMA and AMA, focus on this in their advocacy.  Collaboration among healthcare professionals, policymakers, and patient advocates is crucial in creating a healthcare system that upholds the values of empathy, integrity, and compassion.

I strongly encourage you to take a few minutes to read the article and reflect on what you are experiencing and whether it feels like a moral injury. For things to change we must recognize it ourselves so we can address for us and future physicians.  Together, we can foster a future where doctors can practice medicine with integrity, patients can receive the care they deserve, and the moral fabric of our profession remains intact.