Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First
March 1, 2023
Physicians want to put patients first but struggle to be able to do the right thing. That inability is the subject of this impassioned look at an excessively profit-driven health care system, penned by medical doctors Dean (who co-founded The Moral Injury of Healthcare, a nonprofit group) and Talbot (who co-wrote a STAT news story about the problem). The authors draw their title from the final line of the Hippocratic Oath to do no harm: "May I be destroyed if I betray these words." Tragically, physicians have one of the highest rates of death by suicide. Dean and Talbot cite studies that expose the practice of calling for too many tests and unnecessarily expensive treatments, problems they trace back to the belief that CEOs should be focused on profit and responsible only to shareholders. This corporate mentality broke health care. The authors propose potential fixes such as tying executive compensation to clinician well-being and electing officials who would limit hospital consolidation, address burdensome prior authorization requirements, and change unwieldy demands for doctors' time-consuming note-taking. This is an important call to action.
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March 1, 2023
Doctors often enter the medical field with the desire to help people. This is punctuated by the Hippocratic oath they take, words that most never intend to betray. Unfortunately, the current medical model often prevents doctors from doing what their patients need. Doctors Dean and Talbot, cofounders of Moral Injury of Healthcare, give a name to this incongruity that physicians often feel: moral injury. Their book shows that this occurs because the corporation of healing gets in the way of the practice of healing, and many doctors feel they must act against their deeply held beliefs and convictions. The book gives anecdotal stories of physicians facing moral injury. It also offers solutions for improvement and how to help clinicians put patients first without fear or moral injury. Helping physicians to freely do this can improve the field of medicine for both physicians and their patients. VERDICT This book is great for anyone working with patients, from nurses and doctors to health care and hospital administrators. It puts a spotlight on the problem of moral injury and how to rectify it.--Mason Bennett
Copyright 2023 Library Journal, LLC Used with permission.
Starred review from February 1, 2023
A fierce denunciation of American medicine in which physicians are the heroes--mostly. Doctors Dean and Talbot, founders of a nonprofit called The Moral Injury of Healthcare, explain that "moral injury" occurs when we experience something that transgresses our beliefs. For doctors, that means the oath to put patients' needs first. It's no secret that doctors must now comply with powerful stakeholders in the system, including insurers, hospital administrators, and oppressive regulators, as well as lugubrious electronic medical records. Stories of health care workers suffering "burnout" fill the media, but most blame overwork aggravated by the pandemic. Not so, maintain the authors. The culprit is moral injury, the result of applying aggressive, modern business methods to medical practice. In the introduction, the authors describe a dynamic entrepreneur whose massive hospital earned huge profits by minimizing staff and maximizing testing and services whether necessary or not, and perhaps breaking the law. Finally sent away with a golden parachute, he was replaced by another entrepreneur who promised "significant value for our shareholders." As the authors demonstrate consistently, hospital executives see themselves as responsible to stockholders, not to physicians or patients. This includes many nonprofits, whose administrators give profits priority and benefit from them. Dean and Talbot profile the work of physicians forced to endure moral injury who then try, sometimes successfully, to find a practice more to their liking. In the final chapter, they deliver a passionate plea for more sensible and better enforced government regulation and more generous reimbursement from public and private insurance. Neither seems on the horizon. Sadly, heartless, assembly-line health care is more profitable than the good kind and, despite lurid stories, only slightly less effective. Doctors and patients hate it, but in a nation that worships the free market, profit is evidence of a well-run institution. Pair this powerful book with an equally painful yet important view from the top: Brian Alexander's The Hospital. An expert bottoms-up examination of our diseased health care system.
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