It is not often you can say war veterans and doctors suffer from the same work-related injury, but it appears physicians suffer from “moral injury” at rates similar to those of combat veterans, according to a study in the Journal of General Internal Medicine.
The U.S. Department of Veterans Affairs says moral injury is the distressing psychological, behavioral, social, and spiritual aftermath of exposure to highly stressful events that go against a person’s moral beliefs. Moral injury is often confused with Post Traumatic Stress (PTS), but with respect to military veterans, it commonly means individuals caught in such predicaments as having to kill despite their Judeo-Christian belief that killing is wrong.
This type of mental anguish is becoming more recognized within the medical community, where it is likely the consequence of doctors becoming disempowered in the practice of medicine.
Historically, physicians collaborated with their patients to determine the best, mutually agreed-upon treatment. Today, centralized control has so undermined the doctor-patient relationship that many physicians feel superfluous to care management and are even required to implement treatments they do not agree with.
This artificial constraint on the practice of medicine, combined with obstacles to care and productivity pressures placed upon them by governmental and insurance payers, can make physicians feel disconnected from the care of patients.
Third-Party Killjoys
Physicians have become disillusioned by the destruction of a profession for which many sacrificed their 20s, believing in the nobility of their career. Instead, many caring and compassionate physicians have found themselves battling against a system that obstructs their efforts to provide quality care instead of facilitating it.
In the past, multiple generations of families were physicians. It was not unusual for physicians to say, “my mom was a doctor” or “my dad was a doctor, and his dad was a doctor.” The love of the practice of medicine was passed down and inculcated through generations. And for good reason. As a physician, you get paid to care for people. How cool is that?
However, that changed over several decades. Now, most physicians dissuade their children from following in their footsteps and physician suicide claims the equivalent of an entire medical school every year. Sure, caring for the sick and dying comes with its toll, but never have physicians abandoned the profession and their lives in such numbers.
What has changed is the destruction of the doctor-patient relationship via hurried pace, the abdication of decision-making, and all the other challenges that result from how we finance the health care system.
When doctors work for patients, their responsibility is to those patients. When they work for the insurance-governmental complex, patients are demoted to conduits for third-party payments. This dehumanizes patients and deprives physicians—who are turned into data entry clerks—of joy.
Marcus Welby Returns
Fortunately, a new form of medical care is emerging in the United States called Direct Primary Care (DPC).
DPC physicians work for and are paid by their patients—directly, not by some third-party payer. Thus, their attention is undivided and there are no payer-induced conflicts of interest controlling them.
Many of us remember Marcus Welby, M.D., the early 1970s American television drama starring Robert Young as a compassionate family physician with a great bedside manner. DPC is like that.
DPC docs have smaller patient loads, so they can take more time with their patients in an unhurried approach that allows them to be more thorough and understanding. This less hurried pace is great for patients—who benefit from better, more humanistic care—but also for physicians, who avoid the crush of full schedules of 10-minute visits that sap them of meaning.
Being a physician will always be hard. Every doctor knows this going into the profession. What most don’t know about going in is the soul-crushing bureaucracy that works against them and their patients’ well-being.
DPC returns the physicians to the role of healer. With that restoration, becoming a doctor is something I can certainly encourage my children to do.
Chad Savage, M.D. (info@d4pcfoundation.org) is a Heartland Institute Policy Adviser. Docs 4 Patient Care Foundation policy fellow and the President of DPC Action. A version of this article appeared in Red State on May 18, 2022. Reprinted with permission.
