Pushback Against Toxic Workplace Needed

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Reportedly, about half of American physicians feel “burned out” and thus unable to serve their patients well. The problem is not pathology in physicians, but rather the toxic work environment where third parties pressure physicians to act in ways contrary to their patients’ best interest, writes Vermont psychiatrist Robert Emmons, M.D., in the winter issue of the Journal of American Physicians and Surgeons.

Dr. Emmons suggests that “moral fatigue” is a better label than “burnout” for physicians’ emotional responses to toxic practices. Such practices include surveillance directed toward organizational interests rather than bona fide patient interests; administrative punishment or retaliation for not going along with the organizational agenda; scapegoating clinicians for system failures; excessive certification and testing; and pay below fair market value for clinicians, and above fair market value for administrators.

Moral injury has been defined as a complex of despair and inability to trust that results when moral values are betrayed by persons to whom one must answer, writes Dr. Emmons. Under constant pressure to serve the organization ahead of patients, physicians may experience a long-term stress reaction, consisting of emotional exhaustion, depersonalization, loss of empathy, cynicism, and low feelings of personal achievement.

Dr. Emmons recommends “moral self-care” through the right kinds of alignment with patients and with colleagues. These involve careful listening, explaining one’s thinking, allowing patients to say “no” without penalty, and always putting patient interests first.

He also suggests a “moral firewall,” a “not to do list.” Physicians should strive to avoid identification with toxic organizational practices or terminology, use great caution in engaging with practice guidelines that are designed to serve third-party interests, and avoid financial relationships with third parties whenever possible. He advises politely opting out of surveys that ask, “Are you burned out?”—answers are likely to be sent to a database with the doctor’s personal identifiers.

Physicians who practice the discipline that inoculates them against moral fatigue will be “rewarded with feelings of professional self-value and more satisfying clinical experiences,” Dr. Emmons concludes.

Link to journal article: https://jpands.org/vol24no4/emmons.pdf