It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" 

SableandRed well said, thanks!

Amen

Haha and uninterrupted lunch break is like finding a unicorn on 3rd shift

Amen! "Gee, I hate the bureaucracy and micromanagement, but I just can't ever think of quitting and losing out on the free slice of pizza once a week and the cheap swag we get for nurses' week." Said no nurse, ever.

AMEN!!!! 100%!

I’m writing to offer solutions for the suffering of we healthcare professionals in the face of dominance of our industry by health insurance, national priorities, large-scale medical organizations, the pharmaceutical industry, and the makers of health care technology. This became obvious to me in 1975 when I began working in Tucson as a counselor in a ten-day residential detox program for people addicted to heroin. Full-time salary was $7,000 a year. Dramatic under-funding and over-demand led that and many future programs to collapse and be consumed by larger programs, a churning of professionals and clients damaging to all of us, profitable to a few. The choices are still these: + rigorously care for yourself when working within any institution - establish strong boundaries towards the organization and its demands, and create a lifestyle that feeds your deeper needs + create a national health care union for all providers at all levels: one union + develop anti-trust legislation for health insurance companies which (I believe) are still exempt from same, facilitation collusion among them + create private-practice alternatives to these institutions that do not care about the welfare of the employees, much less the welfare of the patients + take on organizational development activities in settings that recognize that employee turnover is expensive and diminishes their bottom line I started full-time public practice in 1975, and within seven years began a private practice, taking eight more years to achieve full time solo private practice. I took some insurance from 1981 until 2018. I was in the room in 1989 when the insurance company told providers they were “managing care” meaning 20 sessions per year at $60 per session. That compensation remained the same for thirty years. Thirty. Years. Freezing compensation in any industry strangles that industry’s capacity to innovate, expand, and meet the actual needs of its employees and its customers. We exist in a time of frozen health care. Dress warm, keep moving, there are larger forces in the dark than we: organize with some colleagues about how to get individually and collectively out of the woods. Work together - keep the faith - and please vote.

John Smith - this is so impressive. Have you put this on ZDoggMD FB page? Make it part of a searchable public record. Facebook is that. Unless you want to start you’re own Wikipedia page.

welcome to communist party of china where doctors are asked to take the living beating hear t of young people of an minority ethnic group because its time to make money for the big man in the red chair :p

That’s why I have been OUT for 10 years.....I miss caring for patients....but I wasn’t anymore and I hated myself. Now I help people heal in a different way and I love it.

So true; so sad!

@Kiki, you go girl!

@@stephanielemaire6502 What did you switch your profession to?

Vadim Galperin I am a Licensed Massage Therapist.

Est578 it’s so obvious. How have we allowed our profession to be hijacked at the expense of our patients and the torment of our souls as providers? So many middle men profiting off the system. Have any other professions in history allowed this takeover by outsiders at their own peril?

And nurses, and aides, and...

Est578 it goes beyond Dr’s & extend to nurse , therapist

They do have physicians in leadership, but they "turn" once they get into management. Just like when people get into politics, they turn to the dark side. "They" (meaning upper management) will never let a physician in that they can't control. My daughter is going into med school and just had a sit down with one of the physicians she works with in the hospital. He told her to essentially keep her mouth shut and don't be a cowboy or someone that "questions" things. They don't want those kinds. I have worked in medical facilities for 20 +years and usually when someone is loud and vocal and demands change...they are gone. No matter how good they were. You know, without a doubt, that you are always replaceable. And the reality is that we health care workers have sacrificed so much and we have families to feed and student loans to pay off. We can't afford to rock the boat.

@@lisawood365 and the janitors, MA's, techs, every worker paid for the company right on down to the groundskeeper !

Why is it done that way? To presumably prepare you for the "real world"?

For cheap labor...that's the reality. #medicalslavery

I'm just a first year med student who wants to go surgery. I don't know how anyone is physically able to keep up with that workload. I'm going to enjoy my time in med school while I still have a tiny ounce of freedom. Best of luck to you and God bless.

YOU CHOSE SURGERY.

Chris W Eventually, it will be worth it when you are making a ton of money for you and the hospital pushing unnecessary procedures on trusting patients.

He's brave. Be brave.

I wanted to write the same thing. We all know what happens when you bring up something unpopular with "the company". 1st its okay well we will try to fix it. When its not fixed and ur still talking about it. 2nd you start getting bad pt assignments. 3rd start getting crappy hrs. Its like they try to bully u into shutting up. Ive been a nurse for 11 yrs and I wish administration would open their eyes.

@@spartannurse6004 but what should administrators do if the Big Boss only cares about money?

@@AREDEE365 it is not a matter of being brave. I would imagine that many, just as I have, speak up regularly. Many professionals, like me, go against the grain and demand change. Realistically, our speaking out brings on "subtle retaliation" such as being given unsatisfactory positions that are well below our skillset and decrease our pay, given unfounded write ups and/or being fired without true cause. In the long run, speaking up alone does nothing. Especially when very few speak up. When speaking to administration that has little to no understanding of what patient care actually looks like, sadly our words are muted due to their viewpoint on generating more income and reduction in liability at any moral cost.

@@Ot-ej5gi administration does little to nothing out of fear of losing their positions OR lack morality themselves.

I wish you all the best. You must always take time for self care even if it is just 15 minutes a day.

I am so sorry that you are hurting like this. It really isn't fair. My first year out of nursing school, I had intense suicidal ideations. I went down a dark path and felt alone and that it was because I didn't know how to "handle". I assumed everyone else knew how to do it. I was wrong. No one was handling well. and on top of seeing so much suffering, there is so much bullshit to deal with that doesn't have a thing to do with actual patient care. I hope you find your way. Please don't give up. You don't have to be eaten alive. It took me many many years, but I love what I do now. It just couldn't be at the traditional bedside.

Damn Donna. Well said.

Hang in there. You are driven and you will survive. It is our love for people and medicine that keeps us going when it seems hopeless. Choose your residency carefully. Ask them how they support their interns. Choose a field that offers the kind of work/life balance you want. God bless.

carreraenzo90 I hear your compassion and desire to help others. Please, don't give up (yet anyway. You have to do what's right for you), there are many people who will love and appreciate all that you do for them and their loved ones. 🖖🏽

Wow. That's like telling a woman that she is statistically at high risk for being raped so just let it happen. Gross.

U got that darn right! It WILL b used to normalize us, guilt us into picking up shifts "you know...we are short, Susan will hv to take 4 pts if u don't come in....." whatever.....u matter, dint forget we nurses r human and do make misstakes but DO try to do our best for no other reason because it matters to us and God, to do the right thing.....

And...God bless u for choosing medicine!

🥺🖤💭

@hklena6274 How are you now?

Mandy, hang in there. From one clinician to another vent your problems to an understanding source but don't give up. Those of us most vulnerable to breaking are exactly the ones we need in the system to help drive the solution. I'm sorry the system has been such a burden.

Thank you

I would quit, charging $15k/mth to kill someone, can YOU live with that???? Cancer IS CURABLE... and its not with 1950's chemo and radiation torture....

Mandy, I am 53 and a psychiatrist. I worked in this screwed up system for almost 25 years. Through a series of unrelated circumstances I left the hospital/academic system and started working with a friend who runs the mental health system at our local jail. I know all the jokes about prison/jail doctors but before you quit consider looking into some form of correctional health - there's no billing, no care managers and you usually have the time to just take care of your patients. Both the Jail staff and the patients are very happy to see me and I feel much safer working there than I ever did at the hospital (work place violence is a whole other subject for demoralization in my opinion). I've never been happier because, ironically, it's turned out to be the closest to what I had always hoped being a doctor would be - taking care of people who need it most. I hope you won't quit but do what you need to do to take care of yourself!

@@RussellD11 well maybe if we could get food , clothing, furniture and other consumer goods that aren't laced with carcinogens, if we weren't bombarded with microwave, 3 G, 4G and soon 5G, gmo's, lead, mercury, etc, etc maybe the cancer epidemic would stop. "Burn out" is inevitable if what we're doing doesn't solve a problem, it's insanity

I'm so sorry to hear that. The suicide rate for healthcare workers is pretty high, and you see a lot of the same things we do. I hope you can heal. ❤ from this internet stranger.

The stress and anxiety of our veterinary colleagues is not known widely enough. As a physician canine mom of five, 4 angels, and one spoiled, super anxious pittie, thank you for all that you do. My vets have comforted me through my deepest sorrows losing each of my babies. Most physicians don't deal with death as much as you guys do and I definitely understand how that can take its toll on you in addition to the other things involved with patient care and administration.

I believe the word you're looking for is "capitalism"

@@dunder567 I believe the word you are looking for is mammonism.

Indeed. I’m tired of capitalism being short-sighted and ignorant.

Yep! All about money and greed!

@@dunder567 Well, in other countries capitalism is going just fine i think.. America is fucked af :/ I'm gonna be real mad if ya'll re-elect Trump

Satisfaction surveys are the biggest joke ever! Sadly, we are reminded daily, no matter our job, that we are worthless and easily replaced.

@@TheJackmark Sad, but true.

Start therapy. get a diagnosis. File FMLA. Work less. FMLA is the new way to play the game. Is it ethical? It's on the bitter edge but we are pushed to that edge. Oh, stay unionized.

What a classic answer. It translates to "row harder!" You might look at the VA. I just signed on, and it's more gentle there.

Walmart is phasing out greeters.

And now that job is going away.

Agreed.

Totally thought that...school nurses, teachers, and more, same story.

Totally!

My friend is an EMT and shared this with me in a personal post about burnout (the WHO just classified it as a legitimate medical condition today and I strongly resonate with their symptoms and causes) and yeah, 100%. He called them 'frontline jobs'; education providers, emergency services workers, healthcare providers etc, and it fits really well. Sadly.

Yes. A lot of teachers suffer moral injury because they have to violate the ethical standards of the profession by being forced to do harm to students. Excessive testing...mindless curriculum menu teaching...etc.

Ashley Delmar give them credit for trying. Being an administrator is not an easy job. I encourage all front line to give it a try

Yep. While those are nice team building activities, it's like putting new paint on the walls to address a leaky pipe issue. I don't want a pizza party to celebrate a high percentage of survey completion. I'm an adult and can get my own pizza. I do want to the appropriate conditions to give kickass care to my patients. That's what administration is for at the end of the day.

The potluck sounds dangerous!

Exactly. I recognize administrators have a difficult job as well, but when they've been approached multiple times about the working conditions, lack of moral, and burnout, a band aid pizza party solution is totally inappropriate and a slap in the face, especially in the midst of a sucide epidemic across the health care worker board

Maybe there just needs to be fewer administrators to begin with? It seems that as time goes on the number of MBA-level admins has only increased along with the burnout or moral injury in the U.S. healthcare system. Adding layers of management has not helped at all. HR can talk all they want about self care for the employee but it's only lip service.

You so perfectly encapsulated the cancer that is hospital admin and all the bullshit that comes along with them. It was admin that drove me away from the bedside even though I loved my area of nursing (NICU). The most upsetting part about it is that I don’t see this culture of profit over patient care and safety ever changing anytime soon, if at all.

Every industry that the Federal Government gets involved in "regulating" turns to drek.

@@bernadettesandoval3990 Uhh, no. This applies to any industry that focuses on profit and growth too. Corporations/stocks are especially egrigious without government influence.

@@mega17 think again, mega.

And social workers.

And retail pharmacists

That is horrible and I'm so sorry you experienced such loss. I cant imagine experiencing that over and over. If we dont do it quickly, so many of us kill ourselves slowly with self neglect, addictions, high divorce rates and lifelong depression. I hope something in life heals you and our broken American healthcare system.

What did you do instead?

But that you REALLY cannot change. That's human nature. Unless, of course, you weed out the bad seed BEFORE they get into medicine somehow. I propose prolonged volunteering run for ALL medical professionals where they are required to volunteer 40 hours a week for 2 years straight getting paid the bare minimum (like an army system sort of). That would weed out a lot of assholes who go into medicine just to make the money (i.e. egomaniacs).

F!@#Guilt you should have way more likes. This is what has pushed me into a non-clinical career. I’m so embarrassed by the way physicians gave treated me and it has certainly of affected my mental health. I’m not weak for not responding positively to poor treatment, I just came from a healthy background to thus toxic one.

O t if it’s human nature it should be present in all fields. Im only experiencing that from one DNP and a few physicians in my non-clinical role. Nobody else is acting like that.

@@Ot-ej5gi This wouldn't change anything, it would just be another barrier to entry to medicine. Students from rich families will be fine with essentially a two year internship, they would still get the high paying career and prestige that they want by the end of it, and it won't necessarily weed out or improve the character of the applicants. Meanwhile middle and low class applicants would be screwed over by the low pay and the added time before they start making money to pay their debts. Unless you mean that the government would also pay for their housing and other needs, like they would in the military. Volunteering is already a soft requirement to get into medical school and some other areas of training, but it clearly doesn't stop gunners from taking advantage of easy opportunities for work hours, and it doesn't necessarily create better character unless a person already has the foundations for it. The issue with people having nasty personalities is a cultural issue that most people actively contribute to, even if they complain about the effects of it.

Social workers, teachers, doctors, lawyers and all kinds of people. Anyone who has a profession where the system is failing them. Because it doesn't realise they're human and humans need to have connection or they have no reason to live.

Also an aide, working towards getting into nursing school. Yes, its difficult. No one wants to listen, and administrators want to imply you're lazy or ungrateful, rather than admit the entire system has a problem.

Oh, man I'm so curious which corporation you work for! Sounds just like mine!!

Medical videos are incomplete without your comment

Quebec? When I trained there, this was exactly how I felt. I thought other provinces would be better. Moved to Ontario, and it was only marginally so.

Oh my God thank you for that. I had no idea that "wellness initiatives" were coming to that. "such a sick system. mirror to the world we live in

When they say, "balance our wheel of priorities", I understand that to mean, 'do the work of 3 people'.

NPC #47273552 he could start his own group

My dad is the same way and always about 100 charts behind due to refusing to do it in the room

God bless you. I just subscribed to your channel.:)

Same here. At end of day I spend hours at home doing charts but it’s the only way I can get enough time to talk with patients. And still get frustrated by idiotic insurance billing requirements and fighting for treatments to get approved.

I felt that I was beginning to suffocate under an avalanche of, “audits“ that I had to keep up with-but simply couldn’t. As mentioned before we don’t even have time to pee or drink glass of water. I never take my breaks- So I spoke with my supervisor and the solution was for me to come in on my day off. OK I came in on my day off and I work for four hours and I only got through half of the stack of crap I was supposed to submit via the computer- Anyway It’s not just burn out, this whole system is demoralizing. I have to save myself by quitting. I love my residents/patients & i’m going to miss them. It’s very sad how they are treated. I’ve come with medications and find a patient slouching over in their bed asleep and their food tray in front of them -no one‘s offered to feed them. It’s really a sin! I could go on and on but I know you’ve seen worse also The way our administrators treat us is very demoralizing. Shocking!

Not just moral either, the stress of caring for people where the implications of making a mistake could mean death of a patient. Adding more and more BS to the Healthcare worker's plate is just asking for poorer outcomes for patients.

May I kindly ask what it is? I'm looking....

TheMabes69 double gag

thahelp it truly is the broken reimbursement system and not the leaders playing the game. Administrators are generally great people who believe they are doing good for the team and patients by playing the system, because truly there is no alternate

And you have people bitching vets are just in it for the money, when they don't understand all the costs that go in to helping their pets.

I love my vet. You guys are amazing! Thanks for all the work you do!

@Kristen Miller good comment, honestly didn't even think of vets while watching this 👍

In some ways, it's even worse for vets, because it's the animals' *owners* who are giving them so much shit. The very people who ostensibly should care the most for the pet - and they don't want to do what the vet feels is necessary for all kinds of reasons. They come down to money, of course, but an amazing number of people don't even know that veterinarians are actually *physicians* - and in some ways, even more extensively trained than people doctors, because they have to learn about many more than one species. They don't understand that bodies are bodies, and a lot of the same kind of testing and treatment is necessary for a given condition in a dog as it is in a human. My ex had one client actually tell him he thought you became a veterinarian by taking a weekend course or some such! But people don't comply with treatment plans and while that's bad enough for any doctor, at least the average patient is only doing it to his or her own self, but a pet owner is harming a totally innocent creature who has no way of looking out for its own self. The profit margins are razor thin, too, which brings its own bag of stressors for the typical sole practitioner or vet with a small practice. And for vets working for some of the big chains, like Bancroft, they are forced to push all kinds of things on clients that may not even be necessary in the name of making more money, while being expected to see too many patients and not be *allowed* to do many other things that *would* constitute proper medical practice.

I respect all the hard work you all do, but honestly you do not have 1/3 the admin, legal, governmental issues docs have. docs to FTE employee ratio is around 8 to 10 now, and that doesnt include the stuff that is contracted out.

Well, if every hospital had a nurses Union. Not a private contract writing body for wages lobbying but, a group of nurses who ACTUALLY WORK THERE and who represented and lobbied when systemic problems are observed who had REAL power to force rule making committees at the hospital level to make changes to policy. They could order a walk out until problems are addressed. That would be a start.. No change happens without teeth.

Alas, doctors, from what I hear (not there yet) usually can't "walk out" because of the risk for harm to the patients. So to a degree, we're stuck. ... At any rate, I haven't thought of too many ideas yet, save that "intentional mischarting" I read about somewhere on Reddit. What has been done thus far?

@@Nint3ndraw you might want to rethink the idea of intentional "mischarting". The ramifications could be quite dire if proven. There are other ways to do a "get-a-round" that are much less risky and usually very legal. *Things learned on the front lines

@@FGuilt unfortunately, I don't work in a hospital. I'm at a rehab/retirement Facility (nursing home). The problems outlined are a fixture in most, if not all, settings. I'm also in the deep south. Unions are a dying breed here. They have to be voted in by the nurses. Scared nurses who really need their jobs. Jobs that could very easily be lost(not to mention being black balled) if the vote doesn't work out. Yes, I've experienced/participated in a union attempt. Most of the nurses are primary or sole earners for their families. We literally can't afford to walk out or try more aggressively for a union. It gets real ugly, real fast in the trenches. Please don't judge. We're just trying to survive.

Me too ! Fabulous job where I can truly work with my patients

I'm of the same opinion. I agree with most of what he says, but being "burnt out" is a very accurate description of what working for soulless systems and managers will get you. I was feeling burnout just from not being in the right type of job. Being a floor nurse was not what I wanted, but now, I'm working in the ICU and feel much better about my impact on patients. I just had to find my niche. Hopefully I won't burn out too quick, I have a great team to work with.

I was thinking the same thing. Moral injury suggests the "not tough enough"mentality even more than burnout does. What we need is representation. Unionizing at the hospital level where we have real teeth as nurses or doctors to force change is what we need. Not wages lobbying necessarily. But a presentative body to advocate for is just as much as we would LIKE TO advocate for our pts.

@@FGuilt For sure.

Good point, Jason, from another paramedic who did burn out (along with a career-ending back OJI). I think that calling it "moral injury" addresses the root cause of the problem, though, and that is really critical. The term "burnout" also carries its own pejorative implications. Perhaps it is better said that burnout is *caused* by moral injury.

I like the term moral injury because it implies an external cause that should be addressed. You can view burnout as a person's internal issue and therefore it is up to themselves to straighten their shit out. You could improve burnout by meditation for example. Improving moral injury requires changing the system that inflicts it.

Can you imagine being the patient in this mess. We know are medical care is being sacraficed by doctors, nurses trying to hit administrative quotas for their medical corporations as the insurance industries steal the compassion from medical staff and cheat our healthcare in the process. This doctor started 5 years ago singing his tune. It's only gotten worse. How do medical professionals and patients all ban together to repair a damaged healthcare system killing medical professionals and patients.

Not middle school teachers? Hmm.

At least you have lunch, weekends off, holidays off, summers off, retire in 25 years of service, get excellent healthcare, gym discounts, etc. Sorry, I just can't handle teachers whining.....you have no clue what we do! Not discounting your struggle but come on please. Also, nurses are teachers..that's just one of our roles..

@@jac1161 We all have our own struggles. I do get a regular lunch time, but most of the time I'm working with students at the same time as we are eating. My weekends consist of catching up on everything I couldn't do around the house during the week, then heading to the school for 8 hours....ON the weekend. Holidays are nice, but I usually spend extra time working. Summers off? Nope. I spend 80% of my "vacation" time working, training, and planning for the upcoming year. And as a newer teacher, I will not be able to retire in 25 years. Tenure is almost unheard of at this point, and I don't get paid enough to support my family and retire that soon. Healthcare isn't great, either. We pay a pretty great amount because our insurance doesn't cover a lot. Please don't say teachers "whine" for no reason...we endure a lot of physical and mental trauma just like you do. We get berated by the very people we are trying to help, just like you do. We are working in a system that doesn't value us, just like you. The biggest difference is that you had to go to school longer, and get paid more for your time. We all have struggles. Don't speak about it if you haven't lived it.

Be glad you have the right to strike. Many states are anti union. Union busting is alive and well in Colorado.

You won't fix it as a doctor. Run for office. You'll have far more success if that is really your goal.

@@FGuilt it's not my number 1 goal but is something I want to help change. Should reword my comment to "one of the reasons".

Depending on the work culture of your employer, they will either expect you to conform or get lost. Fighting from the inside of a malignant system is often futile. Praying you will make a positive difference no matter where you go.

Agreed. While I support what he is saying, using explicit language and "we out" isn't professional and, in a way, I feel it undermines the message.