moral injury – The Health Care Blog

Moral Injury: A Physician’s Premature Retirement

Jun 28, 2023

BY HAYWARD ZWERLING

Synopsis:

After a 3 decade career in a solo private practice the healthcare environment shifted
As an employed physician, my institution’s policies hindered my ability to care for my patients
The consequent moral injury left me unwilling to re-engage with the healthcare industry

I retired early from the profession that I loved because the devolution of the healthcare system had made it impossible for me to provide care to my patients in a manner which met my own standards. The resultant “moral injury” left me leary of again becoming involved with our healthcare system in the near future.

My Early Career

Although I had originally planned a career as a physician-scientist, it became apparent toward the end of my training that this was not the best career path for me and I choose to pursue a career in private practice.

My first post-training job was as a physician working in a clinic owned by Blue Cross and Blue Shield (1989-1991.) After two years in this relatively low stress environment it became clear that taking care of young, healthy patients was not much fun nor interesting.

I then joined Dr. LP’s private medical practice where I learned how to run a private practice. It was in this setting that I began to create an electronic medical record program for my practice, ComChart EMR. ComChart evolved into a minor commercial endeavor, it was a hobby that earned me some money, and it connected me to many interesting physicians around the US, some of whom I continue to hear from to this day.

After a couple of years practicing alongside Dr. LP I decided it was time to strike out on my own. I built out a new office and soon thereafter added a nurse practitioner.

Healthcare Has a Moral Injury

Feb 13, 2020• 1

By KIM BELLARD

The term “moral injury” is a term originally applied to soldiers as a way to help explain PTSD and, more recently, to physicians as a way to help explain physician burnout. The concept is that moral injury is what can happen to people when “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

I think healthcare generally has a bad case of moral injury.

How else can we explain physicians practicing surprise billing, hospitals suing patients, health plans refusing to pay for pre-authorized treatments, or pharmaceutical companies charging “skyrocketing” costs even for common, essential prescription drugs? There are people involved in each of these, and countless more examples. If those people haven’t suffered a moral injury as a result, it’s hard to understand why.

Melissa Bailey, writing for Kaiser Health News, looked at moral injury from the standpoint of emergency room physicians. One physician decried how “the real priority is speed and money and not our patients’ care.” Another made a broader charge: “The health system is not set up to help patients. It’s set up to make money.” He urged that physicians seek to understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”