However, today more than ever, we are threatened with opposing forces that are causing us to lose our identity. Our identity is intertwined with deeply personal connections with our patients that are unique from all other types of relationships. Patients confide and share things with us that they often share with no one else. According to the American College of Physicians, patients want and need a number of attributes in a physician: knowledge, expertise, kindness, caring, attentiveness, a willingness to explain, and offers of reassurance. “Healthcare provider” is a marketplace term that is hardly accurate to describe this cherished relationship between a physician and patient. But rather industry attempts to redefine us and our service as a business commodity. Dr. Wendy Dean, a psychiatrist from Washington, D.C., describes the difficulties, frustrations, and some of the burnout that physicians have been experiencing lately. According to Dr. Dean, this is not burnout. She says it is much, much worse. It is moral injury that's being imposed upon physicians. In fact, Dr. Dean feels that calling out burnout is a false attempt to try to blame physicians for our inability or lack of resilience in dealing with changes in practice which are beyond our control, when actually the true problem is our healthcare system. She defines moral injury as perpetrating or bearing witness to acts that transgress deeply held moral beliefs. In other words, physicians take an oath to provide the best care to their patients and are taught from the beginning of their training that patient care is their first priority. But then physicians are limited by the business framework of healthcare. What we know is best for the patient is ultimately restricted, denied or deferred by the economics of the healthcare system - what the insurer will allow or even what's best for the hospital system. The term burnout implies that what we feel is our fault, that we are not well enough, that we do not care for ourselves enough, that we are not resilient enough. But we know that no amount of meditation, exercise, or wellness lectures are going to help what ails us when our patient is denied necessary surgery by their insurance company, or when a patient needs a certain medication that's not on their insurance formulary, or when a patient needs a referral to a specialist that isn't allowed because that causes leakage outside of the corporate healthcare system which hurts the economics of that system. According to Dr. Dean, “There's no amount of wellness that will allow us to be resilient to those kinds of insults.” Until we can allow physicians to think primarily about what is in the best interest of their patient, we aren't going to solve the problem. As physicians we need to look at the symptoms and define the cause of this identity crisis. Physician frustration is not caused by flaws in our character but flaws in a system. As an organization, we need to work together to try to fix it. While the technology and finances of the business of medicine have driven the changes, we have allowed the central physician - patient relationship to diminish in importance just as we have
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