阅读医⽣的体⼒被繁重⼯作透⽀了，但是良知尚未被泯灭
医⽣常常被视为神圣的天使，他们⼯作在抢救⽣命的第⼀线。没有他们，或许世界被更多忧郁所笼罩；没有他们，更⽆法想像明天⾛向何⽅？
越来越多医⽣的体⼒被⽇复⼀⽇繁重⼯作透⽀的同时，他们的良知也被潜移默化地泯灭了——商业化、⽣意经，让他们躲闪不及了。
难怪有医⽣悄悄感叹到，这次疫苗事件与我⽆关，否则，真的不知道怎样⾯对家⼈，⾃⼰的孩⼦和社会的信任？
医⽣给⼈们的印象总是聪明、坚韧不拔、也最有耐⼼。如果他们想做好什么事⼉，他们⼀定会耐下⼼来，发挥⾃⼰的聪明机智，把事情做好，让患者满意。
Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor.
噶玛兰Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury(精神伤害)。
Moral injuryis frequently mischaracterized. In combat veterans it is diagnod as post-traumatic stress; among physicians it’s portrayed as burnout.
But without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the conquences.
Burnout is a constellation of symptoms that include exhaustion, cynicism, and decread productivity.
More than half of physicians report at least one of the. But the concept of burnout resonates poorly with physicians: it
More than half of physicians report at least one of the. But the concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physici
ans have finely honed during decades of inten training and demanding work.
Even at the Mayo Clinic, which has been tracking, investigating, and addressing burnout for more than adecade, one-third of physicians report its symptoms.
We believe that burnout is itlf a symptom of something larger: our broken health care system.
生命源泉
The increasingly complex web of providers’ highly conflicted allegiances — to patients, to lf, and to employers —and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collap of resilience.
The term “moral injury” was first ud to describe soldiers’ respons to their actions in war.
It reprents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, n of morality, and relationship to society.”
The moral injury of health care is not the offen of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.
Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people.
Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges.
Each hurdle offers a lesson in endurance in the rvice of one’s goal which, starting in the third year of medical school, is sharply focud on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing —this is the crux of conquent moral injury.
In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment.
Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himlf or herlf— lead to conflicts of interest.
货舱Electronic health records, which distract from patient encounters and fragment care but which are ex
traordinarily effective attracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions.
The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits.
矿山法
Patient satisfaction scores and provider rating and review sites can give patients more information about choosing a physician, a hospital, or a health care system. But they can also silence physicians from providing necessary but unwelcome advice to patients, and can lead to over-treatment to keep some patients satisfied.
Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.
Navigating an ethical path among such intenly competing drivers is emotionally and morally exhausting. Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand.描写螃蟹的作文
Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. The routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care.
Physicians are smart, tough, durable, resourceful people. If there was a way to MacGyver themlves out of this situation by working harder, smarter, or differently, they would have done it already. Many physicians contemplate leaving heath care altogether, but most do not for a variety of reasons: little cross-training for alternative careers, debt, and a commitment to their calling. And so they stay — wounded, dingaged, and increasingly hopeless.元宵节活动方案
In order to ensure that compassionate, engaged, highly skilled physicians are leading patient care, executives in the health care system must recognize and then acknowledge that this is not physician burnout.
Physicians are the canaries in the health care coalmine, and they are killing themlves at alarming rates (twice that of active duty military members) signaling something is desperately wrong with the system.
The simple solution of establishing physician wellness programs or hiring corporate wellness officers won’t solve the problem.
Nor will pushing the solution onto providers by switching them to team-bad care; creating flexible schedules and float pools for provider emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques or participate in cognitive-behavior therapy and resilience training.
We do not need a Code Lavender team that dispens “information on preventive and ongoing support and hands out things such as aromatherapy inhalers, healthy snacks, and water” in respon to emotional distresscris.
Such teams provide the same support that first responders provide in disaster zones, but the “disaster zones” where they work are the everyday operations in many of the country’s major medical centers. None of the measures is geared to change the institutional patterns that inflict moral injuries.
What we need is leadership willing to acknowledge the human costs and moral injury of multiple competing allegiances. We need leadership that has the courage to confront and minimize tho co
mpeting demands.
小孩低烧怎么办
Physicians must be treated with respect, autonomy, and the authority to make rational, safe, evidence-bad, and financially responsible decisions.
Top-down authoritarian mandates on medical practice are degrading and ultimately ineffective.
We need leaders who recognize that caring for their physicians results in thoughtful, compassionate care for patients, which ultimately is good business.
Senior doctors who knowledge and skills transcend the next business cycle should be treated with loyalty and not as a replaceable, depreciating ast.
We also need patients to ask what is best for their care and then to demand that their insurer or hospital or health care system provide it — the digital mammogram, the experienced surgeon, the timely transfer, the visit without the distraction ofthe electronic health record — without the best interest of the business entity (insurer, hospital, health care system, or physician) over riding what is best for the patient.
A truly free market of insurers and providers, one without financial obligations being pushed to provid
ers, would allow for lf-regulation and patient-driven care.
The goals should be aimed at creating a win-win where the wellness of patients correlates with the wellness of providers. In this way we can avoid the ongoing moral injury associated with the business of health care.
Simon G. Talbot, M.D., is a reconstructive plastic surgeon at Brigham and Women’s Hospital and associate professor
Simon G. Talbot, M.D., is a reconstructive plastic surgeon at Brigham and Women’s Hospital and associate professor of surgery at Harvard Medical School.
Wendy Dean, M.D., is a psychiatrist, vice president of business development, and nior medical officer at the Henry M. Jackson Foundation for the Advancement of Military Medicine.真好的英文
