On Modern Medicine and Moral Injury

"But now we have a rare opportunity to work together and channel this energy in order to create a better, more sustainable future for us all."

From trucking convoys to gilets jaunes to counter-protests, anger appears ubiquitous. And in talking with colleagues, reading survey results, and listening to online fora, it is clear that many doctors are also feeling frustrated and burnt out. 

Much of this moral injury has to do with a reversal of expectations. We went to medical school to help people and to train in a system where we could do our best. However, what has evolved has instead moved us away from working to our scope of practice and helping patients. Rather, there is a crushing burden of administrative work from forms and faxes. Most electronic medical records still do not talk to each other and have not fulfilled the promise of improving efficiency. Improved survival has meant that patients often have multiple medical conditions and require complex care. There is an expectation to be available at all times. The costs of living and running a practice are increasing. Payment models have incentivized episodic care and many younger career doctors are worried they will not be valued for doing what we know is the best care. And for some, they cannot even get a job or, if they can, they cannot access resources such as operating rooms or get privileges to work in a facility. 

At the end of so much training, so many exams, so much delayed gratification, and so much given of ourselves and our families, we are faced with a reality that cannot meet our great expectations and often greater debt. 

But I remain hopeful.

The new physician master agreement creates a framework to change these paradigms. It allows us a stronger voice with government and health authorities to advocate for the healthcare system that patients and their healthcare teams deserve. Within our profession there will be an allocation process to address the disparity between Sections that can cause animosity and feelings of disrespect. We improved our ability to work with Sections to create fees and payment models that encourage needed services. There is ongoing commitment to the Joint Collaborative Committees to continue the work of Patient Medical Homes and care networks that will support team-based care comprising primary care doctors, consultants, allied healthcare professionals, and of course, patients themselves.

There is good reason why we feel the way we do. But now we have a rare opportunity to work together and channel this energy in order to create a better, more sustainable future for us all.

- Dr Eric Cadesky