Moral Distress In Healthcare: Time To Fight Back

Check it out, Z-Pac. I’ve been thinking about something recently, this idea of moral injury we’ve talked about before, or how healthcare workers really are burning out because they’re suffering this conflict. They wanna do the right thing for the patients, but they don’t have the tools or the resource or the autonomy.

Here’s the thing though. When I was really thinking about it, it’s this idea that we actually are trained, for the most part, to do the right thing for our patients. As human beings who are born with an innate morality, and it’s conditioned over time, when it turns out that we are prevented from doing the right thing for another human being, that causes moral distress. You actually feel that. Now unless you’re a psychopath and you can turn that off, or you’ve conditioned yourself to believe to lie to yourself that you’re doing the right thing for patients. If you’re forced, by say, a big health system that you work for to cut corners, to spend less time with patients, to refer them to specialists that are only internal when you know damn well that there’s a better specialist across the street at another organization.

Man, I’ll tell you this used to happen to me occasionally. You realize, okay, in this hospital there’s certain set of cardiologists and it’s a community hospital, but aww man, I know that the guys at my other institution where I round are much better. And if this were my mom, I would not let this guy touch her, but I would send her other there. But what do you end up doing? You’re there, there’s politics, and there’s also rules on who you can refer to and getting a transfer’s not gonna be paid by insurance. So what do you do? You bite the bullet, and you refer to Doctor Dingdong who is not gonna do a good job, who’s probably gonna cath her for reflux disease, and he’s gonna potentially cause harm while enriching himself.

Now what does that feel like as a healthcare professional who actually is a reasonably good person and wants to help people? Feels like is what it feels like. And you do that again and again and again and again. And it’s codified by your health system that’s like, “No, you did the right thing. “That’s the way to do it.” But you know you didn’t do the right thing. You know, and what happens? You take that suffering home. You somehow express it in very maladaptive ways whether you’re detached from your family, whether you’re yelling at your wife or kids, whether you’re drinking, binge-drinking on the weekend. That does not go away. It comes home to roost in your life.

Now when this Chinese water torture of moral distress happens again and again and again, and it’s encouraged by systems that are run by people that care about the bottom line because medicine is a business. When that constantly happens, good people in a terrible system start to break, and that’s what we’re seeing. Until we all wake up as frontline health care professionals and we stand up and say, “This is wrong, this is not okay. “This is hurting me, it’s hurting our patients, “and it’s damaging everything “that we stand for as healers.” Until we stand up together against this, until we push back and resist, it’s gonna get worse and worse and worse. And you know the worst part about it? Is that then we’re gonna start selecting, for nurses and doctors, who don’t give a . ‘Cause those are the only people who can work in a f’ed up system like this. And then we’re done, you guys. So here’s the call to action.

We can’t take this lying down, and we can’t stand up alone ’cause we’ll get beaten down by hierarchical system. You know it. We all have experienced it. I’ve experienced it. When you go back with the power of numbers, when everyone on your team says, “We’re no longer gonna do this.” Right? When we design systems that actually encourage us and allow us to do the right thing for patients, when we start to actively weed out bad doctors, bad nurses, instead of being complicit and afraid.

Oh, we complain about them, the eye is gonna turn onto us, and we’re actually scared. Maybe we’re doing something wrong, and we don’t wanna put the spotlight on us. Wake up, you’re a good person, you try your best. Stop living in fear. And stop tolerating people who are taking advantage of others and are inflicting this moral distress on you. All right, guys? So do me a favor, share this video. If you like, become a supporter. We talk about this stuff unfiltered because outsiders aren’t allowed in including those pesky anti-vaxxers. All right? And get woke, okay? We out.

[Tom]- Also, I gotta get this off my chest, Z. Today I morally distressed Penn Jillette at the airport, and I just wanna say, Penn, if you’re out there, I’m sorry, bro. I shouldn’t’ve accosted you at the airport, but I just, I felt like, you know, I had to. You know?

– I’m glad you did it, Tom Hinueber, because he is a skinny, potato-eating piece of . Hear that, Penn? Mister Skeptic. Are you skeptical of potatoes? No, you eat them.

– [Logan] Cut.