Burnout vs. moral injury: Does it matter what we call it?


Yes, we think it does. And the time to act has come. The time is now.

We — physicians and nurses — work side-by-side caring for patients, every single hour of every single day. But we don’t often talk to each other about the (seemingly insurmountable) deep and serious issues and challenges we as clinicians face, practicing in today’s broken health care system. That has to end. We must unite.

We are the only ones who intimately know the uphill battles we encounter, as we try to provide the best care possible — as we pledged to do — for all who present themselves to us citizens (insured/uninsured) and immigrants (documented/undocumented), alike.

For those not in the trenches alongside us, it’s true that it feels war-like at times: from relentless skirmishes with EHRs, to being reduced to a subordinate in the chain of command while seeking to plant a flag on today’s “pre-authorization summit,” to staffing shortages, to loss of autonomy, to Press Ganey scores, etc.

We are dedicated professionals who are not afraid of long hours and hard work, even to the detriment of our own well-being. Heck, we were trained to work long and hard! We were not trained to be victims or to have our values, integrity, and meaning and purpose co-opted by others.  To be sure, we — the 4.6 million U.S. doctors and nurses — belong to different tribes, but we’re on the same side facing a common enemy…profit-driven health care above all else.

Increasingly during the past 10 to 15 years, the literature and research has focused on the high rate of burnout symptoms and the (perceived) need for greater clinician resilience. In July 2018, a seismic shift in thinking began with Drs. Simon Talbot and Wendy Dean’s article in STAT: “Physicians aren’t ‘burning out.’ They’re suffering from moral injury.” In the months since, that shift has resulted in animated conversations and articles — and a clarion call — heard around the world.

On April 25, BMJ published “Sixty seconds on . . . moral injury,” to summarize the message of Andrew Goddard, president of the Royal College of Physicians, at RCP’s annual conference that day in England. “What we call burnout — that sense of despair, hopelessness, and loss of joy — is not a failure of the individual. It is a failure of the environment they work in, the culture of the workplace, the workload imposed on them.” Goddard went on: “Yes, we all can improve the working lives of those around us but until we sort out the workplace, we will all continue to be ‘injured by it.’ How we treat each other and work together impacts directly on our patients.”

To answer the clarion call, we must begin to gather face-to-face — and create time and space — to talk, organize, and strategize about taking back our seat at the table, so we can begin to affect change in the workplace … the places we work. Whether we think of ourselves as leaders or not, as practicing clinicians, we all indeed are leaders (starting with our own teams).

We need to revisit the words, ideas, and high ideals of our patron saints: Sir William Osler and Florence Nightingale. They are as relevant and inspiring today as they were more than a century ago. They can help remind us why we chose our professions. And when we remember… the feelings of cynicism, hopelessness, and ‘being stuck’ (we’ve experienced for far too long) will be banished. We will rediscover our strength and fortitude that had been shrouded in darkness, under the opaque guise of us not having enough “resilience.”

When we begin to come together, learn we have common purpose and common ground, and start cultivating that ground, two things will happen: 1) we will know we are not alone; and, 2) we will become a unified force to be reckoned with. We will be part of a burgeoning cadre of colleagues — scattered near and far — who also believe change is possible and can happen — because we are prepared to make it happen.

The new message — the true message — has little to do with burnout and what we lack. It has to do with the moral injuries we suffer from the slings and arrows we attempt to dodge (not always successfully) in order to care — and advocate — for our patients to the best of our ability. Sadly, some of us are mortally wounded…as attested to by statistics gathered of our friends and colleagues who have died, and continue to die, by suicide.

We are resilient. We’ve always been resilient. It’s time to take control of our narrative, reestablish agency, and reclaim our power.

Camille Adair, William Norcross, Sam Slishman, and Tami Berry serve on the board, The Osler Symposia.

Image credit: Shutterstock.com


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