Moral Injury in Health Care

(AP Photo/Michael Burke)

(The opinions expressed in guest op-eds are those of the writer and do not necessarily represent the views of

How often can you say that war veterans and doctors suffer from the same work-related injury? Not often, but that appears to be the case after a recently published study found that physicians suffer from “moral injury” at rates similar to those of combat veterans.


According to the U.S. Department of Veterans Affairs, moral injury refers to the distressing psychological, behavioral, social, and spiritual aftermath of exposure to highly stressful events that go against a person’s moral beliefs. Often confused with post-traumatic stress disorder (PTSD), it is commonly used in reference to military veterans who are caught in such predicaments as having to kill despite its prohibition by the Sixth Commandment in the Judeo-Christian belief system.

Surprisingly, this type of mental anguish is becoming more recognized within the medical community. This is likely the consequence of doctors becoming disempowered in the practice of medicine. Historically, physicians worked in collaboration with their patients to determine the best, mutually agreed-upon treatment. However, in today’s medical system, central control has so undermined the doctor-patient relationship that many physicians feel superfluous to care management and even must enact treatments that they do not agree with. Combined with this artificial constraint, obstacles to care, and productivity pressures placed upon them by governmental-insurance payers, physicians often feel disconnected from the rewarding care of patients.


Physicians are becoming disillusioned by the destruction of a profession for which many invested years of training and education with the unrealized belief that their career would be a truly noble endeavor. Instead, many caring and compassionate physicians now find themselves battling against a health care system that places obstructions in the way of being a quality physician instead of facilitating it.

In years past, being a physician was commonly a multi-generational pursuit. It was not unusual for physicians to say “My mom was a doctor,” or “My dad was a doctor and his dad was a doctor.” The love of the practice of medicine was passed down and inculcated through generations. And for good reason. As a physician, you get paid to care for people. How satisfying is that?

However, over the past several decades, something changed. Now, the vast majority of physicians dissuade their children from following in their footsteps and physician suicide claims the equivalent of an entire medical school’s worth of physicians every year. Sure, caring for the sick and dying comes with its toll, but never have physicians abandoned the profession and taken their own lives in such numbers.

Something has changed, and that something is the destruction of the doctor-patient relationship via hurried pace, abdication of decision-making, and all the other challenges that result from how we finance and run the health care system. When the doctor works for his or her patients, their responsibility is to you. Yet, when they work for (or within) the insurance-governmental complex, the patient is degraded to the substrate through which the financial transaction occurs. This is dehumanizing to the patient and joy-depriving for the physician who is now transformed into a mindless data entry drone.


Fortunately, a new form of medical care is emerging within the United States. It is called Direct Primary Care (DPC). DPC physicians work for, and are paid by, their patients. Thus, their attention is undistracted and the payer-induced conflicts of interest that in effect control the physician are removed. DPC providers also have smaller patient loads. This means they can take more time with their patients in an unhurried approach that allows them to be more thorough and understanding. This less-hurried pace is great for patients who benefit from better, more humanistic care. Moreover, it is a healthier environment for the physicians who avoid the crush of non-stop 10-minute visits, which ultimately saps them of developing solid relationships with their patients.

Being a physician will always be difficult. Every doctor knows this going into the profession. What most don’t know is the sole-crushing bureaucracy that works against their patients’ well-being, not to mention themselves. DPC, in a nutshell, returns the physician to their rightful role as healer. With the physician restored to their role as healer, being a doctor is something I can certainly encourage my children to do.


Chad Savage, M.D. ([email protected]) is a Heartland Institute policy adviser, Docs 4 Patient Care Foundation policy fellow, and the President of DPC Action.



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