Moral injury is driving people to quit their jobs, especially in healthcare. But this may actually be an opportunity for REAL transformation.

Here was the video I did early in the pandemic about never forgetting how we were treated. And here’s a pre-pandemic video on moral injury.
Transcript Below

The PayPal Tip Jar!

– [Zubin] Hey everyone, Dr. Z. So there’s been a lot of talk in the press lately about the Great Resignation, millions of people quitting their jobs and in health care, this is particularly pronounced. Now, why would that be? Why would nurses, doctors, pharmacists, housekeepers, why would they quit, when for many of them, they were called to this profession? It was a deeper calling. It was about helping other people and living their authentic truth, so why would they quit? You know, what’s interesting about this is it’s not like this is new. Healthcare sucked for many people before COVID. This was something we talked about on this show quite a bit. We talked about moral injury, this idea that we call healthcare workers burned out because it’s an easy way to blame a victim, right? It’s an easy way to say, you’re not strong enough, you’re not resilient enough, and you couldn’t hack what’s a really hard job.

So maybe you should meditate, maybe you should go get some lavender essential oils. Maybe you should get a massage, take a little “you time.” Let’s do a little corporate wellness stuff. We’ll hire a consultant. We’ll hire a corporate wellness officer. We’ll do these kinds of things that will, you know, help with your resilience, and I think what people realized very quickly when they introspected is that they were miserable. There’s a deep, deep, deep, deep suffering that was happening, and it’s, it’s many could not put their finger on what it was, but they were miserable. For many, they felt trapped in a job by loans, by expectations, by social pressure, by identity issues. Imagine you trained most of your adult life to do some medical thing, whether you’re a doctor, a nurse, a pharmacist, whatever it is, physical therapist, occupational therapist, dietitian, and you’re miserable.

You’re absolutely unhappy. You’re emotionally detached. You feel completely unaccomplished. You feel like an imposter doing what you’re doing. You’re worried you’re going to hurt somebody. Maybe you’re abusing substances. Maybe you’re clinically depressed, but you’re scared to talk about that because you have to disclose that on your license renewal or to get your hospital privileges. You feel like you are treating a computer screen instead of the patient in front of you, and you didn’t go to school and sacrifice your 20s to do that. You work for an organization that’s owned by a private equity firm whose bottom line is the bottom line, not patients, not you. You are a resource in an assembly line of Health 2.0, where the product is a patient that got through the system and they could bill for. You are paid and your system is paid to do things to people, not to do things for people.

You feel expendable. You’ve been told you’re expendable. The leadership of your organization has told you that if you quit, you will never find work that is as good as this, that has the benefits and the privileges, and you will be blacklisted. So don’t you dare try to leave. You’re morally conflicted because you know the right thing for that patient in front of you is for you to spend that extra five minutes getting to understand their hopes, dreams, and fears, understand why they’re resistant to getting a vaccine or whatever it is instead of having to chart in front of the patient in order to get through your day so you’re not cutting into pajama time with your kids, and you’re saddled with all this debt, so you’re afraid that if you leave, you’ll lose your identity and you’ll lose your livelihood and you won’t be able to support yourself or your family, your family, by the way, who’s already miserable because you’re miserable, and because you can’t be present with them because of this distraction of mind that has you back at work even when you’re at home.

That was before COVID for many, many, many, many, many people. Now I was one of them. Now, what happens during COVID? You guys remember that I did a video in the beginning of the pandemic saying, there will be a reckoning. We will never forget what happened in the early days when there was no PPE, and where was the leadership, and we were asked to risk lives, our lives, the lives of our family during a pandemic, and the public was shitting on us, afraid to go near somebody in scrubs, ostracizing us at gas stations because we were wearing scrubs because they were afraid of this disease, and then, you know, leadership puts up a sign: “Heroes Work Here.” Well, that got better, they got some PPE. Then what happens? Wave after wave, after surge, after surge, which if you go on social media, there are people denying that it even happened, and you’re going every day risking your life taking care of patients who are dying for which at those stages of illness we have nothing.

We have nothing we can do, prone patients dying in the ICU, most of them elderly, most of them with comorbidities, dying alone, and we are tasked with enforcing the hospital rule that a patient must die alone, even though it feels in every way, morally, ethically, psychologically wrong, spiritually wrong, but we’re the arbiters of that. Then we’re asked to do overtime shifts. Then we’re asked to continue to suck it up and given pizza slices. Pharmacists are asked to vaccinate the entire population and given pizza while continuing to work under metrics, oppressive metrics at places like CVS and Walgreens, and then they get yelled at by patients because they had to wait.

Patients will come to the ICU with COVID having declined vaccination and continue to ask for ivermectin and hydroxychloroquine and be so misled by the misinformation online and by ideology and so on with good intent, they’re good people, and then healthcare workers have to deal with that when they know that to some degree this is preventable. Now you add all of this to the fact that when people do quit, they’re replaced by traveling nurses, say, who make 2-3X what the people who stayed are making, and they have to work side by side. Now in the setting of all this, in the setting of all, and it’s worse, it’s worse than this.

It gets worse and worse and worse. In the setting of all this, in many places there’s great leadership. In other places, leadership has its head so far up its own ass, it can’t even acknowledge the suffering of these frontline heroes. They use platitudes and garbage talk, and then they do the opposite. So instead of actually giving them raises, and I know it’s economically hard, or some other support, the tools, the resources, the autonomy to do their job. They don’t burn out because the work is hard. They burn out because they can’t do the work they know is necessary to help you, the patient. That’s why they burn out, because they’re morally injured. Burnout is the end stage. It’s the dialysis of chronic disease, which is moral injury, death by a thousand paper cuts, and then, and this is why I’m doing this video today, because something interesting happened this morning. My wife is a Stanford faculty. She’s a radiologist at Stanford. I was at Stanford for about a decade.

Stanford has this really good perk for their staff and faculty, which is, there’s this beautiful gym. There’s several gyms. There’s one here down the road. It’s not on the main campus and faculty and their spouses, as one of the benefits of employment, so in other words, shave a little off the wages, you get this. They get to access this facility for free, free, right? Remember, who built this facility? The work of these people, seeing patients every day, teaching students as university professors. So we have this wonderful perk. Now my wife got me a membership. So I go in the morning and I usually exercise for an hour or two, and it’s where I catch up on reading, learning, researching, and getting into a very meditative state. I find the place like a church. So the beautiful thing is, although Stanford charges its staff and faculty for parking, they don’t charge for going to the gym because guess what? If you’re going to promote wellness, make it easy. Design a system so that people will get there easily without any obstruction.

It’s hard enough to get to the gym. So they had, I don’t know, 10 or 15 spots with signs that says, for gym parking, 90 minutes free. That was wonderful. So that’s where I park. Today I drove up and I parked there and I noticed that the sign had changed. It said, C permit. Now a C permit costs $70 a month for faculty. So I looked at this and said, huh? And I noticed the whole parking lot has been empty the whole time. I mean, it’s not like it’s full, ’cause this is not patient parking. This is all staff. So it’s a totally empty parking lot across the street from the gym. So I walked in the gym and the staff said, I said, Hey, what happened to the parking? And the staff of the gym said, huh, your guess is as good as ours. Overnight, they went in, changed all the signs and made it paid. It now costs money and all of our, you know, clients here are just outraged and I was like, they didn’t even tell you guys? I’m like, well, the frontline people didn’t hear about it. So I said, oh, this is interesting.

A hospital employee walked in, was like, hey, what happened to the parking? And they said, oh, they just changed it, and you could see on this person’s face, here I am working for this hospital through COVID, giving everything, and they can’t even give me free parking for a gym to make myself better, more, more resilient, which is what they keep talking about. They can’t even do that. This is our leadership that will talk out of one end of their mouth about wellness, and they take our fucking parking away. You know, it’s like in “Office Space” where they take his stapler and it’s the, it’s the final paper cut of 1,000 that breaks the camel’s back. I could feel for this guy. You know, I, what is wrong with us when we manage instead of lead? We need to overthrow this entire system. We deserve better, a system that’s self-governed. Why shouldn’t a housekeeper have a say in the governance of the organization and have autonomy over his or her own job? The tools, meaning technology to do our job, the resources, meaning team, to do our job, the autonomy, meaning the flexibility to do what we know is right, with support. We need leaders that will point us to that and allow us to lead in our own way, and part of that is turning inward and looking at our own situation and going, no, this is not me, you know?

So I’ve had people reach out in leadership saying, Zubin, can, can you start talking about how we might retain employees better? Because people are leaving and our staffing gets worse. It’s a vicious cycle because people quit, and then it makes it harder on the existing staff and then it’s harder to recruit and so on, and I said, well, how about this? How about not sucking? Because I tell people if they look inwards and this is not their thing, and they’re miserable and they can’t change it, they need to walk, and now’s the time to do it at a time when there’s inflation and job pressure and all of a sudden, people are hiring and they can’t hire enough people. Hey, now’s the time to wake up and go, is this even what I’m supposed to be doing? That’s, it’s not the Great Resignation, people. It’s the Great Awakening, that’s what this is. It’s the Great Awakening, when we look inside and realize that, no, we’re better than this. We’re more loving than this. We’re more connected than this. We have a purpose in this life and it’s not this.

So let’s find it, let’s reconnect with it, and that means transforming our organizations by transforming us. It starts right here with us. Otherwise we get the system that reflects us, reflects our egoic delusion. That’s what it is. That’s really what it is. So the Great Awakening means it’s time to look inwards, and that means leadership needs to look inwards. We need to stop giving lip service to wellbeing, wellness, burnout, all this other garbage, garbage talk. It’s well-meaning, there’s good intent. Our leaders are good people for the most part. We’re just, we’re, we’re, we’re trying to break this into little parts when we’re not seeing the whole, right, and the whole begins with this. It begins right here, right here. You know, search inside. Many of you know this is true already. You just don’t know what to do about it. Well, now’s the time. Maybe it means going to a different organization that respects you, maybe it means supporting organizations that are Health 3.0 minded, meaning team-based, supportive of the team, self-governing, lots of leadership in all levels, non-hierarchy, not, not a dominator hierarchy, like our current business model. See, who thought that running medicine as a business model was the right fit for a healing art? When did we think that was okay? Did you know this? Look, it doesn’t matter.

They will socialize medicine just to solve this problem, and they’ll make everything worse because you haven’t solved the problem. The problem is, our care model is completely antiquated and wrong, and we need a completely, transcendently different model, which we’ve talked about on the show many times, where you’re actually paid to do the right thing for patients and the right thing for each other, where you do well financially by doing good, where the moral injury is resolved because there isn’t the conflict. Self-governing like an organism, self-evolving, anti-fragile, it gets stronger when you challenge it. Right now, we have a fragile garbage system that would crumble. The minute the pandemic came, the whole thing fell apart, and then the resiliency of the people actually brought it back together. They white knuckled their way through it, and they get thanked by taking their, giving them parking for free and taking it away. It’s one thing to never have it. You know, we’re just used to being crapped on, but to give it and then take it away without any notice, like, think how that hospital employee felt. So valued.

So there was an article in “The Atlantic” about the Great Resignation in healthcare, and they talked about an ER doc, who she thought she was a lifer in ER, and just got so injured during COVID that she finally plucked up the courage, despite all the identity. I mean, we doctors, our entire identity is being a doctor. It’s like a, it’s like this inner child that we’ve nurtured and grown all this time, and then you’re saying, oh, just walk away from it. I mean, how do you do that, right, but she plucked up the courage and did it, and in the article, she found herself in a pumpkin patch with her kids for Halloween, after she left, and found herself sobbing, and the reporter asked her, well, why, why were you sobbing? And she said, I was happy, and I hadn’t experienced that in so long. Yeah, we need to reconnect with who we are, and as a system. If you’re in leadership, connect with that. Feel it, feel into it. You kind of know what the right thing to do is, right.

We’re all pulled in a million ways, million different directions, and COVID made it a ton worse. Now we’ve lost the ability to have compassion for people who are afraid of the vaccine, because of all the information online, their own belief. They’re good people trying to make rational decisions and we call them anti-vaxxers and we brand them as dumb and all this other stuff. How’s that working out for us? How is that working out for convincing them to, to get vaccinated or to do the, whatever the right thing is, we think the right thing is for them? Not very well, I’ll tell you that ’cause I get the emails. All right. So I’m going to keep talking about this stuff and it’s not going to make me very popular.

No one’s going to hire me to speak. I don’t care. I really don’t, ’cause when I talk, when I do talks for nurses and doctors and these virtual talks, I’m real with them, and you know what? A lot of these organizations, if they’re, if, if they’re any good, they’re down with it, because they understand that we need this new anti-fragile way of being in the world and it starts with us. It does. We can’t keep externalizing blame, like you can blame that parking spot as the last straw. That’s fine, but it’s on you if you take that sitting down. Yeah. It takes courage, it’s really scary. It does. All right, guys. I really love you, I really do. Really. I’m trying to, I’m trying to bring this from a place of love and you see I get angry, right, ’cause that’s what I feel and it comes through, but then you let it go, but I think we really need to authentically understand how we feel about this and what it means. All right, guys, I love you. Please share the video. We’re out.