Doctors Struggle With ‘Moral Injury’ Caused by Business Side of Health Care

By Melina Wisecup

In modern day healthcare, who is really in charge of how patients are treated? Healthcare providers are starting to speak out about how the business side of the industry can interfere with doctors providing the best care for patients. Some call it a “broken healthcare system.”

Former psychiatrist Dr. Wendy Dean and microsurgeon Dr. Simon G. Talbot realized that they both experienced similar external pressures—red tape they have to cut through in order to get patients the proper care they need. Not only do these pressures interfere with their jobs, but for a doctor that can mean interfering with saving a life.

“Every physician takes an oath when they leave medical school…we promise that we put our patients as a priority,” Dean said. “Then we get out into practice and we realize more and more that the business framework of healthcare gets in between our ability—what we know is best for the patient—and our ability to take care of them. And as that happens day after day, month after month, year after year it amasses into a moral injury.”

Dean and Talbot started calling it the “moral injury” of healthcare. The term is normally associated with military members who experience a conflict in their hearts or souls when they feel they have acted against their deeply held moral beliefs. The two published an article in Stat News expressing how they felt the term applied to health care. Not long after, Dean and Talbot were flooded with emails from other healthcare professionals who said they could relate.

Dr. Nick Sawyer from UC Davis said he has also experienced moral injury. He told Kaiser Health News a story about a patient who had a kidney stone and was in pain. He could not get surgery because her insurance plan did not deem the stone an “emergency.”

“The health system is not set up to help patients. It’s set up to make money,” Sawyer told the site.

After realizing that many healthcare professionals were also suffering from moral injury, Dean and Talbot started a nonprofit to raise awareness about the struggles doctors other healthcare providers are facing under today’s healthcare system and regulations.

“In my case, hospitalization for patients is another one… you would have to call and justify what their symptoms were, the risks that they were at. The person on the other end of the phone who had never seen the patient would be saying, ‘yes that qualifies no that doesn’t qualify.’ And so that became a real dilemma for me. How can I, in good faith taking good care of this patient send them back home when I know that’s a risk and that they aren’t going to be getting the care that they need,” Dean said.

If the medical industry keeps going down this path, Dean said future doctors may feel less encouraged to invest in their inner-calling, which could lead to even more problems in the healthcare arena. She says returning to an environment where doctors can invest in that inner-calling, and where their knowledge is valued, are the first steps to making a change towards genuine patient care.