Autonomy, mastery, respect, and fulfillment are key to avoiding moral injury in physicians

Simon G Talbot and Wendy Dean
BMJ blogs
Originally posted 16 Jan 20

Here is an excerpt:

We believe that distress is a clinician’s response to multiple competing allegiances—when they are forced to make a choice that transgresses a long standing, deeply held commitment to healing. Doctors today are caught in a double bind between making patients’ needs the top priority (thereby upholding our Hippocratic Oath) and giving precedence to the business and financial frameworks of the healthcare system (insurance, hospital, and health system mandates).

Since our initial publication, we have come to believe that burnout is the end stage of moral injury, when clinicians are physically and emotionally exhausted with battling a broken system in their efforts to provide good care; when they feel ineffective because too often they have met with immovable barriers to good care; and when they depersonalize patients because emotional investment is intolerable when patient suffering is inevitable as a result of system dysfunction. Reconfiguring the healthcare system to focus on healing patients, rebuilding a sense of community and respect among doctors, and demonstrating the alignment of doctors’ goals with those of our patients may be the best way to address the crisis of distress and, potentially, find a way to prevent burnout. But how do we focus the restructuring this involves?

“Moral injury” has been widely adopted by doctors as a description for their distress, as evidenced by its use on social media and in non-academic publications. But what is at the heart of it? We believe that moral injury occurs when the basic elements of the medical profession are eroded. These are autonomy, mastery, respect, and fulfillment, which are all focused around the central principle of purpose.

The info is here.

Nine risk management lessons for practitioners.

Taube, Daniel O.,Scroppo, Joe,Zelechoski, Amanda D.
Practice Innovations, Oct 04 , 2018

Abstract

Risk management is an essential skill for professionals and is important throughout the course of their careers. Effective risk management blends a utilitarian focus on the potential costs and benefits of particular courses of action, with a solid foundation in ethical principles. Awareness of particularly risk-laden circumstances and practical strategies can promote safer and more effective practice. This article reviews nine situations and their associated lessons, illustrated by case examples. These situations emerged from our experience as risk management consultants who have listened to and assisted many practitioners in addressing the challenges they face on a day-to-day basis. The lessons include a focus on obtaining consent, setting boundaries, flexibility, attention to clinician affect, differentiating the clinician’s own values and needs from those of the client, awareness of the limits of competence, maintaining adequate legal knowledge, keeping good records, and routine consultation. We highlight issues and approaches to consider in these types of cases that minimize risks of adverse outcomes and enhance good practice.

The info is here.

Here is a portion of the article:

Being aware of basic legal parameters can help clinicians to avoid making errors in this complex arena. Yet clinicians are not usually lawyers and tend to have only limited legal knowledge. This gives rise to a risk of assuming more mastery than one may have.

Indeed, research suggests that a range of professionals, including psychotherapists, overestimate their capabilities and competencies, even in areas in which they have received substantial training (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Lipsett, Harris, & Downing, 2011; Mathieson, Barnfield, & Beaumont, 2009; Walfish, McAlister, O’Donnell, & Lambert, 2012).

Fat Shaming in the Doctor's Office Can Be Mentally and Physically Harmful

American Psychological Association
Press Release from August 3, 2017

Medical discrimination based on people’s size and negative stereotypes of overweight people can take a toll on people’s physical health and well-being, according to a review of recent research presented at the 125th Annual Convention of the American Psychological Association.

“Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers,” presenter Joan Chrisler, PhD, a professor of psychology at Connecticut College, said during a symposium titled “Weapons of Mass Distraction — Confronting Sizeism.”

Sizeism can also have an effect on how doctors medically treat patients, as overweight people are often excluded from medical research based on assumptions about their health status, Chrisler said, meaning the standard dosage for drugs may not be appropriate for larger body sizes. Recent studies have shown frequent under-dosing of overweight patients who were prescribed antibiotics and chemotherapy, she added.

“Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice,” Chrisler said. “Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients.”

In some cases, providers might not take fat patients’ complaints seriously or might assume that their weight is the cause of any symptoms they experience, Chrisler added. “Thus, they could jump to conclusions or fail to run appropriate tests, which results in misdiagnosis,” she said.

The pressor is here.

Empathy is an overrated skill when dispensing medical care

Karin Jongsma

Aeon Magazine

Originally published December 15, 2016

Here is an excerpt:

In fact, this final requirement is most closely related not to empathy but to compassion – defined among emotion researchers as the feeling that arises when you are confronted with another’s suffering, including the desire to help. This non-empathetic compassion – a more distanced love and kindness and concern for others – might act as a bridge between recognising the other’s feelings and providing care without the detriments of empathy. Since compassion does not require identification with the patient, it can help in performing good care as a professional duty, building trust, and treating someone according to his or her needs, while avoiding cognitive biases and empathetic distress.

Empathy still matters in healthcare settings that don’t require action: self-help forums and family-support coordinators can be guided by empathy. And precisely because empathy is biased, physicians should be trained to critically reflect upon their empathy gaps rather than be told to fake it.

The article is here.