By KIM BELLARD

The term “moral
injury” is a term originally applied to soldiers as a way to help explain
PTSD and, more recently, to physicians as a way to help explain physician burnout. 
The concept is that moral injury is what can happen to people when “perpetrating,
failing to prevent, or bearing witness to acts that transgress deeply held
moral beliefs and expectations.”  

I think healthcare
generally has a bad case of moral injury.  

How else can we explain physicians practicing surprise billing, hospitals suing patients, health plans refusing to pay for pre-authorized treatments, or pharmaceutical companies charging “skyrocketing” costs even for common, essential prescription drugs?  There are people involved in each of these, and countless more examples.  If those people haven’t suffered a moral injury as a result, it’s hard to understand why.  

Melissa Bailey, writing for Kaiser Health News, looked at moral injury from the standpoint of emergency room physicians.  One physician decried how “the real priority is speed and money and not our patients’ care.”  Another made a broader charge: “The health system is not set up to help patients. It’s set up to make money.”  He urged that physicians seek to understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Maria Fabrizio for KHN

David Oliver, a British
physician, has an example of doing that: hospital gowns.  In The
BMJ, he argues that “there’s no dignity in hospital gowns,” noting: 

“There are sometimes entirely legitimate reasons for using gowns—for example, in critical care or surgery or for some imaging or interventional procedures, where easy access to the whole body is vital. But that’s not the case for most patients for most of their stay. Yet still we use the gowns, or we keep people wearing them well beyond that immediate need.”

 Dr. Oliver compares the process of being admitted to the hospital to being jailed—”people having their possessions bagged

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