Moral Injury, Moral Courage, and the Business of Medicine

I do want us to sort of interrogate this concept all over again through the eyes of my co-host and friend, Saul Weiner.

Saul, do you have a feeling of sympathy, empathy, having been a doctor in more than one healthcare system today?

I see things quite differently.

I would expect you to.

I

wish physicians were more distressed by what happens to patients in our healthcare system.

I think patients often need to be protected from physicians' moral compromise.

There are so many studies showing that physicians continue to do highly invasive procedures, whether it's in orthopedics or cardiology or pain medicine.

that have been proven or well-documented to be ineffective, but that make lots of money for physicians.

And I understand that physicians are under a lot of pressure to do these procedures because they're rainmakers for their hospitals.

And that to me is not a reason to violate their oath.

Physicians are very easy to corrupt in a corrupted system.

And so I think that if we're going to talk about the way in which our system has become financialized, we can't just describe physicians as victims of that process who are morally injured.

We have to recognize that they are very powerful agents.

They're not passive agents.

and that there's so much that they can do.

I don't buy the argument that they're trapped.

You know, if you think of a soldier in battle who finds himself forced under orders and death to shoot innocent civilians and then lives with agonizing doubt about that.

That is moral injury.

I think that when somebody is upset about their work-life balance and they start to hate their job, that's not moral injury.

That's understandable burnout.

That was moral injury, so.

Well, it's one of the items.

In fact, it was the number one item in your survey.

And if you look at, if you think about constructed-