The Moral Crisis of America’s Doctors

Dean’s essay also caught my eye. Because I have spent most of the past few years reporting on moral injury, interviewing workers in simple professions whose jobs are ethically compromised. I spoke to prison guards patrolling violent prison wards, illegal immigrants toiling in industrial slaughterhouse “slaughterhouses,” and factory workers working on offshore drilling rigs for the fossil fuel industry. Many of these workers were hesitant to speak up or be identified because they knew they could easily be replaced by someone else. By comparison, doctors are privileged, earn six-figure salaries, and hold prestigious jobs that escape the drudgery of many other members of the workforce, such as nurses and administrators in the medical industry. board. In recent years, however, many doctors, despite the respect associated with their profession, have been forced to work in car factories or Amazon warehouses, where productivity is tracked by the hour or pressured by management to work. I found myself exposed to practices common among manual laborers. Faster.

Doctors are highly skilled professionals, not easily replaced, and I suspect they are not as reluctant to talk about the dire conditions in their workplaces as the low-wage workers I interviewed. I was thinking But the doctors I contacted were afraid to speak up. “I’ve had second thoughts, but I don’t think it’s something we can do right now,” one doctor wrote to me. Another texted, “I need to be an anon.” Some of the sources I tried to contact had signed confidentiality agreements that prohibited them from speaking to the media without permission. Some feared they would be disciplined or fired if they pissed off their employers, a concern especially well-founded as private equity firms take over and expand the reach of the health care system. It seems In March 2020, an emergency room doctor named Ming Lin was removed from the hospital’s rotation after expressing concerns about Covid-19 safety protocols. Lynn worked at St. Joseph Medical Center in Bellingham, Washington, but her actual employer was Team Health, a company owned by the Blackstone Group.

ER physicians are at the forefront of this trend as more hospitals outsource emergency department staffing to cut costs. A 2013 study by Robert McNamara, director of emergency medicine at Temple University in Philadelphia, found that: 62% of U.S. emergency physicians can be fired without due process. Nearly 20% of the 389 ER physicians surveyed were threatened or waived from Medicare or health insurance for raising concerns about quality of care, harming those receiving treatment. respondents said they were pressured to make decisions based on economic considerations that could result in Patients on Medicaid or encouraged to order more tests than necessary. In another study, he more than 70 percent of emergency physicians agreed that incorporation in their field had a negative or very negative impact on the quality of care and their job satisfaction.

Of course, there are many doctors who love their work and feel no need to speak up. Clinicians in high-paying specialties such as orthopedics and plastic surgery are “doing well, thank you,” joked a doctor friend of mine. But more doctors believe the pandemic has simply exacerbated the strain on an already dysfunctional health system that prioritizes profits over patient care. They are aware that their focus on profit routinely exposes them to moral shackles, and young doctors in particular are wondering how to resist. Some are wondering if the sacrifices and compromises are worth it. “I think a lot of doctors feel like something is bothering them. To tell. She said the term moral injury was originally coined by psychiatrist Jonathan Shay to describe the wounds that form when a leader betrays one’s sense of what is right in a high-stakes situation. I point out that there is. “Not only do clinicians feel betrayed by their leadership, but if they allow these barriers to get in the way, that becomes part of the betrayal,” she says. . They are tools of treachery. “

until a while ago I told the emergency doctor (let’s call her A) about her experience. (She didn’t want to use her name, but explained that she knew several doctors who had been fired for expressing concerns about poor working conditions and patient safety issues.) Demeanor A soft-spoken woman called the emergency room. It was a place she loved to work in, calling it a “sacred space” because it could have such a big impact on her patients’ lives. During her training, her terminally ill patient told her that her daughter could not come to the hospital to see her die. Mr. A promised her patient that she would not die alone, and continued to hold her hand until she died. Such exchanges would be impossible today, she told me. There’s a new emphasis on speed, efficiency, and relative value units (RVUs). RVU is a measure of physician reimbursement, and some people reward doctors for performing tests and procedures, such as listening to and talking to patients they feel discourages doctors. This is to avoid spending too much time on low-paying tasks. “It’s all about her RVU and going faster,” she said of the ethos that permeates the sites she’s worked in. “Time from door to doctor, time from room to doctor, time from first evaluation to discharge.”

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