If you work in healthcare you have probably heard about the concept of ‘burnout.’ It seems like everywhere I turn I am hearing people talk about feeling “burned out,” whether it is regarding their job, being a parent, being a student, or just general adulting. We all get tired of having to deal with the same stressors over and over, but I’d like to introduce another term into the burnout conversation: “moral injury.”
Moral injury is a term that is considered a more accurate way of describing physician burnout, since it places the burden of responsibility not on the individual healthcare worker, but on the system one works within. This term was initially used to describe the difficulties military vets faced after engaging in behaviors during wartime that violated their own moral codes outside of that context. Healthcare workers are at significant risk for moral injury due to the high-intensity nature of their work environments and the systemic and team factors that result in health care providers being “forced to make decisions that transgress their professional commitment to patient comfort and care, and forcibly shift their moral compass” (Judd 2022). Moral injury happens because physicians and other health care workers are frustrated they can’t provide the care they trained for and promised to give.
Here are the common symptoms:
Feelings of guilt ("I did something bad") or shame ("I am bad") about one's actions
Feelings of betrayal, anger, or grief and loss
A feeling that one has no more empathy or compassion left to give
A sense that one is unforgiveable or irreparably flawed
Significant and persistent negative changes in behavior such as mistakes, social isolation, compulsive behavior (e.g., overworking, overeating), or changes to sleep patterns
Take this self-assessment to learn more!
If you are affected by moral injury, what can you do about it?
Seek out others to assist in making difficult choices when possible
Find support about circumstances that cause moral distress
Challenge your self-talk, e.g. shift from telling yourself "I should have done better," to, "I did the best I could, given the circumstances."
Take care of yourself--and challenge the trend that healthcare workers prioritize caring for others over caring for themselves
Work to make meaning of your experience and find a sense of purpose in addressing systemic problems in healthcare
Read/listen to how one psychiatrist is managing burnout symptoms including, "becoming physically angry about emails," in this NPR story
Access available mental health services, coaching, or peer supports
What can you do if you notice some symptoms in a colleague or friend? How can you support others who are struggling with moral distress? Here are some ideas:
Gently bring their attention to any changes you perceive: "I've noticed you have seemed a little down recently."
Let the person know you are willing to talk/listen
If the person chooses to talk, be nonjudgmental and understanding: "That must have been incredibly hard. I can't imagine how I would feel in that situation."
Ask for more information: "It sounds like you've experienced some things that nobody should experience. Can you help me understand how that's impacting you now?"
If it's too hard for you to listen to another's story, say something like: "I don't know if I can hear this story right now, but I know someone who can. I can connect you to them."
If possible, try to help the person gain a different perspective on how they view themselves or others. They may be telling themselves they should have been able to prevent a bad outcome or that they were solely responsible for what happened. You may be able to help the person see a broader perspective on what happened, remind them what they could or could not control, or highlight their strengths and core values.
Working in healthcare has its fair share of challenges as well as its rewards. Until our system works better, use these ideas to take care of yourself as well as your friends and colleagues! Contact me today if you’d like to process how your work has impacted you and how to reconnect to your sense of purpose working in medicine.
