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Moral Injury

The Loss of Dignity in Medicine

A Personal Perspective: Mourning the indignities of medicine.

I take orthopaedic call two to three times per month. We work a full day, then we are available all night, then we work a full day the following day.

In my 20s this was tiring but invigorating. In my 30s this was doable, and balancing babies and a pager in the middle of the night was just normal in my world. In my 40s I got tired—tired and sometimes grouchy. Now that I am in my 50s I am struck with a new word to describe the interactions the physician community encounters on call, and it has been reverberating in my mind recently: indignities.

Recently, a gentleman broke his hip in the middle of the night. This is a painful injury, and most patients are downright scared. After reviewing his x-rays, learning his medical history, arranging his surgery with the operating room team, and coordinating with the team in my clinic, I went to do the part of my job that means the very most to me: I went to talk to my patient.

I pulled a chair up by his bedside. His tired eyes and my tired eyes met. I showed him his x-ray and told him about the surgery that would fix his painful broken bone. He had a lot of questions, and I was answering them. He was in the middle of a question when a nurse came into the room and somehow stood between me and my patient, with her back to me, and began speaking to him about his medication schedule.

He stopped her. He asked her to let us finish our conversation and to return later. And here's the kicker: He apologized to me.

Mortified does not begin to describe how I felt. There were a few ways this could have played out for my patient. He could have lost trust in me as his surgeon. He could have decided that I was not a respectable or capable physician, given that another member of his team of clinicians disregarded me in this way. Alternatively, he could have concluded that the physician-patient relationship is not important to our team in my hospital.

I did not ask him how the interruption made him feel. I did not have it in me to acknowledge the unprofessional interaction. I did not want to risk coming off as divisive or critical. So I walked away and avoided a conflict. I did the surgery well. I took good care of my patient. He did well.

Yet this indignity has been weighing on me because it is not an isolated incident. The climate of healthcare has taken a direction that has angered me for years.

But anger is often unexpressed sadness. Recently, I have found it more honest and healthy to just let myself be sad. I am mourning the culture that allowed doctors to have time with our patients.

When I started my career as a surgeon, the era of respect for the space for surgeons and patients to connect was still supported—even, dare I say, sacred. The relationship began before surgery and went on well after surgery. Holiday cards and personal connections were still the norm. At that time, I could not imagine a nurse interrupting a conversation about surgery between a scared patient and his surgeon.

I actually do not blame the nurse. I have been thinking about her perspective. She has so many metrics to answer to, so many computerized checkboxes to fill, so many patients and so little time. Our organization is so large that she does not know me and I do not know her. She has been trained in an environment that is quite foreign to me. She and so many others like her are doing their very best to get through the day.

As I continue to grieve the loss of respect in my profession, I will not abandon hope. I will try my best to make my patients feel respected. As I teach the next generation of physicians, I will instill in them the old-school approach to patient care that I cling to. In this way, I vow to do my part to stave off the extinction of dignity in medicine.

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