Why It’s Hard to Put Patients First | Wendy Dean, MD

First used in the context of Vietnam war veterans, the term "moral injury" refers to the psychosocial, behavioral, and spiritual distress that comes from perpetuating or witnessing events that contradict deeply held moral beliefs. In recent years, moral injury has increasingly been used to describe one of the main challenges clinicians face in modern medicine — the challenge of knowing what care patients need but being unable to provide it due to constraints beyond the clinicians control, such as limited time or misaligned financial structures. Even more than emotional exhaustion and detachment, moral injury leads to profound shame and guilt. One of the leading voices addressing moral injury among health care workers is Wendy Dean, MD, a psychiatrist who has written widely on the issue, most recently in her book, If I Betray These Words: Moral Injury in Medicine and Why it's So Hard for Clinicians to Put Patients First. In this episode, Dr. Dean shares her own winding journey from orthopedic surgery to general surgery and finally to psychiatry, discusses where moral injury comes from and what it looks like, and explores what clinicians can do to address it.

In this episode, you will hear about:

Dr. Dean’s early explorations in medicine - 2:35
How Dr. Dean’s desire to become a surgeon was deterred by gender discrimination - 5:12
What led Dr. Dean to psychiatry, and then eventually out of clinical medicine entirely - 13:22
A discussion of what moral injury is and why Dr. Dean began to study it - 18:03
Examples of how moral injuries occur in the day-to-day of medical practice - 24:19
How physicians and hospital administrators can address moral injury, citing as an example the court case of Raymond Brovont M.D. vs EmCare Holdings Inc - 38:57
Dr. Dean’s advice for how navigate and push back against seemingly insurmountable bureaucracy - 42:22
Moral Injury in Healthcare, the non-profit Dr. Dean founded - 47:39
What setting personal and professional boundaries looks like in medicine - 53:04
Dr. Dean’s advice to students and clinicians about fighting burnout - 57:37

In this episode, we discuss Achilles in Vietnam: Combat Trauma and the Undoing of Character by Jonathan Shay, MD, PhD, and The Business of Health Care is Built on the Exploitation of Doctors and Nurses by Danielle Ofri, MD, PhD.

Dr. Wendy Dean is the cohost of the Moral Matters podcast.

You can follow Dr. Dean on Twitter @WDeanMD.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.