In this episode we continue with the discussion of moral injury. I can boil it down to a single concept:

If you are thinking that you are unsure of whether or not you can continue to remain moral and ethical in your current practice, you have moral injury.

The ideas in this episode are tough. How do we educate medical students to be aware of this concept? How do we empower physicians to deal with it? How do we work around administrations that are indifferent and only serve a spreadsheet? How do we work with sympathetic administrators who actually do want a healthy physician and clinician group but are constrained by insurance companies and regulations in their options to work toward that?

The cynic will shout “Nationalize all Health Care”. But here is a news flash, The VA is federalized medicine and moral injury is not a stranger in the VA. Large bureaucracies don’t work well toward the goal of building familiarity and common understanding of local group needs.

This is a very tough topic.

We end with a discussion on physician unions. The dialogue doesn’t make that a panacea either. Private practice folks cannot unionize for some reason but employed physicians can unionize. But keep in mind, what does a strike look like? The reality is that like air traffic controllers, you can have a union but do you strike when it means you are not caring for patients?

I ran this long because we had enough content for 2 episodes but not quite enough for 3, so forgive me.

Wendy Dean MD Twitter @WDeanMD

Simon Talbot MD https://physiciandirectory.brighamandwomens.org/details/1847/simon-talbot-plastic_surgery-boston

Moral Injury https://fixmoralinjury.org/

Burnout

https://www.aafp.org/fpm/2015/0900/p42.html

https://www.npr.org/2016/12/08/504864961/when-a-psychologist-succumbed-to-stress-he-coined-the-term-burnout

The Mini Z

https://www.vumc.org/health-wellness/sites/vumc.org.health-wellness/files/public_files/PDFs/wlc/wlcMiniZ.pdf

Malach Burnout Scale

https://en.wikipedia.org/wiki/Maslach_Burnout_Inventory

Fiduciary Responsibility
http://www.businessdictionary.com/definition/fiduciary-duty.html

Press-Ganey Scores

https://www.pressganey.com/About/News/Patient-Satisfaction-Scores-Optimizing-The-Patient-And-Clinician-Experience

Pay Parity

https://www.nursepractitionersoforegon.org/page/news20160225/Legislature-Votes-to-Make-NP-Payment-Parity-Law-Permanent.htm#:~:text=Oregon's%20nurse%20practitioner%20payment%20parity%20law%20is%20the%20first%20law,they%20perform%20the%20same%20services.


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Intro and Outro Music:
Corals Under the Sun by Sivan Talmor
Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA
Edited by: Todd Fredricks DO
Cohost: None, I did this after hours and you know work rules for students
Disclaimers: Todd Fredricks, DO
Cut Clip: None… we are getting there with production

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Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

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