Viewpoint: How US healthcare system affects physicians' moral wellbeing

Moral injury is a phrase rooted in war history used to describe how soldiers would justify difficult actions taken during combat, but Lisa Doggett, MD, realized she and other medical professionals were experiencing a similar feeling related to patient care.

Dr. Doggett worked in community clinics in the Austin, Texas region for many years and is now the senior medical director at Sagility — formerly known as HGS AxisPoint Health. 

Watching her patients navigate a strained healthcare system often led to a moral and mental strain she was left with after the fact, she explains in a narrative published Aug. 2 by NPR.  

When a patient needs care urgently, but expresses they cannot afford costs associated with something like an unplanned visit to the ER, clinicians are left wondering if convincing them to go and get the care they need does more harm than good. 

"I have to steel myself against overwhelming feelings of helplessness when I'm there, wanting to assist, not knowing how," Dr. Doggett writes. 

Patients who come in with unmet needs ranging from needing better shoes, stable housing, or a medication they can't always afford can be challenging to file away as "cared for" even after giving them the care they came in to get, because patient needs and challenges often reach beyond health system walls, she explains. 

This moral injury can further exacerbate the burnout physicians feel even at well-resourced hospitals and clinics, she argues. 

"Despite some efforts to move away from a 'fee-for-service' payment model, in most cases, our system still rewards volume of patients seen over value of care provided," Dr. Doggett explains. 

The path to true change, Dr. Doggett says, must be paved with more robust social determinants of health, participation and further collaboration with social workers, caregivers, therapists and better technologies to navigate a patient's history.

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