President’s Letter

First, Do No Harm

Tiffany K. Kim, MD

As I sat in front of a patient recently and went through all the preventative recommendations, I realized I should be saying “Do as I say, not as I do.” When was my last mammogram?? Two years ago! Oh, that colonoscopy I should have had at age 40 because of family history…almost four years later, yep still haven’t done it. This isn’t because I don’t believe in the evidencebased screening recommendations, nor is it that I don’t think it is important. Time just slipped by. I encourage many patients every day to do what I haven’t. Why? There are many reasons why physicians may not follow the adage Do No Harm for themselves. Sometimes it can just be life and the busyness of it that causes us to not do what we teach. (Hmmm…maybe we need to remember that when patients come back without completing our orders!) But are there other reasons we are not taking care of ourselves like we recommend for our patients? Burnout? Moral injury? Something else? The continuing weight of administrative tasks that get put on physicians, in addition to their actual job or more often “calling,” which is to take care and heal. It can feel like a ton of bricks. The term “burnout” was coined by German psychologist Herbert Freudenberger in 1975, who identified it as the presence of symptoms like malaise, fatigue, frustration, cynicism, and inefficacy that emerge when the workplace makes excessive demands on energy, strength, or resources of workers. The staff burn-out syndrome in alternative institutions. But the phrase BURNOUT has a lot of physicians shaking their heads and rolling their eyes and denying their symptoms…why? In their STAT article, Physicians aren’t

‘burning out.’ They’re suffering from

moral injury, Drs. Talbot and Dean write that “the concept of burnout resonates poorly with physicians. It suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work.” What is moral injury? Originally used in reference to war and what soldiers experience once they return home, a/k/a PTSD. It has been since used in the context of physicians. “Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury” according to Drs. Talbot and Dean. As physicians, we are here because we want to help others, put patients ahead of everything else. That is our calling. So why is doing what we love also causing us so much pain? Physician suicide is soaring in the United States. What is in the way? Everything…hospital administration, electronic medical records, insurance companies, the list goes on and on. When we know what a patient needs to get better, but all the constraints make it impossible, too many hoops, to get to where we need to be…that is our moral injury. So, knowing what to call it is half the battle – how do we fix it, so the next generation of physicians won’t have the same experiences? Well, from the sounds of it, it isn’t going to be an easy or quick fix, but if we all work toward that goal it is possible. Here are some of the recommendations from Drs. Talbot and Dean from their article, Reframing Clinician Distress: Moral Injury Not Burnout.

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“The concept of burnout resonates poorly with physicians. It suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work.”