June 9, 2023

Something is wrong. You can feel it, but you cannot put your finger on it. You go through the motions daily, but your joy is gone-its soul-sucking. Your patients sense it too. They used to love coming to see you, but now they see the changes. The light has gone out of your eyes. You used to love your job, but now it feels like a burden. This is not burnout. This is moral injury.
Moral injury occurs when our ethical code is violated. It can happen when we witness an act of atrocity or when we are the ones who commit an act that goes against our moral beliefs. For physicians, moral injury often occurs when we are forced to sacrifice our patients’ well-being for efficiency or profit. For example, we may be asked to see too many patients daily to provide quality care or be pressured to prescribe unnecessary tests and treatments. When we cannot uphold our ethical standards, we experience moral injury.
Moral injury is different from burnout because it is not caused by stress or exhaustion. It is a type of soul- damage that can lead to depression, anxiety, and even suicidal thoughts. If you are struggling with moral injury, it is essential to seek help from a mental health professional who can help you process your emotions and develop a plan to move forward.
As a physician, you made an allegiance to serve your patients and do no harm. However, sometimes the best for the patient isn’t the best decision based on work policies, written and unwritten. You may feel trapped and stuck in a hard place. Your frustration might build as you see other team members not being held to the same standards. When this occurs, it is essential to identify the core values causing this dissonance. Is it possible to discuss this with your supervisor to find some middle ground?
It is also necessary to take some time for yourself-burn out is accurate and will only impede your ability to make clear decisions. If you find yourself in this position, try to remember your why. Most likely, you went into medicine to help people. Of course, this doesn’t always mean following orders; sometimes, it means going against them. Most importantly, trust your gut; if something feels wrong- it probably is.
After over ten years of clinical practice, I reached my crescendo. The maximal point at which I told tolerate practicing medicine.
I felt taken for granted and knew I had to make changes immediately. My relationship with medicine felt like a toxic, one-sided relationship. I had to make significant changes, so I didn’t lose my soul—my passion for truly helping people. My conscience didn’t allow me to be complacent and part of perpetuating the problems. So, I decided to find my voice. Being a doctor isn’t just about science and technical skills. It’s also about connecting with patients on a human level, which requires empathy and communication. Unfortunately, the current medical system often doesn’t allow room for these things. We’re overworked and understaffed, focusing on output rather than the quality of care. This has to change. We must start valuing doctors as human beings again, not just cogs in a machine. Only then will we be able to provide the kind of care our patients deserve.
My love for working one-on-one with patients and seeing their lives change entirely fuels my passion for this work. Seeing is believing, and I think everyone can heal themselves; they just need the proper tools and guidance. In my opinion, knowledge is power, and once people know how simple lifestyle changes can create such profound results, they will be empowered to make changes in their own lives. I am living proof that holistic medicine works, and I intend to help others experience the same level of success in their own lives.
You can also take steps on your own to start healing from moral injury. These include:
With time, effort, and support, you can heal from moral injury and find a way to move forward.
However, ultimately the “cure” for moral injury depends on health care leaders and people who have the power to change policy. We need strong leaders with the charisma and the tenacity to support positive changes in her health care system. Physicians will continue to leave the profession because everyone has a breaking point. No one is immune to moral injury.
We must start at the top if we want to heal the healers.
Tomi Mitchell is a family physician and founder, Dr. Tomi Mitchell Holistic Wellness Strategies. She can be reached on Twitter @DrTomiMitchellFacebookPinterest, and Clubhouse.
Image credit: Shutterstock.com
Primary Care, Psychiatry
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