The stress and strain of the pandemic have taken a toll on the healthcare community, with many practitioners left with emotional burdens that may never leave them. A decade ago, these physicians may have been described as suffering from burnout. This terminology, however, suggests that the physician simply needs to find an outlet for their stress, like meditation, or perhaps they should just scale back their workload.

In other words, burnout implies that the problem lies with the physician and not the circumstances being acted upon them. What physicians are suffering from is more accurately described as moral injury. This term was first coined to describe soldiers who returned from the Vietnam War and were burdened with the knowledge that they acted under orders in a way contrary to their moral compass. In an article published in the Federal Practitioner, the following description is provided to help clarify the term in its application to physicians, “Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the health care context, that deeply held moral belief is the oath each of us took when embarking on our paths as health care providers: Put the needs of patients first.”

The pandemic has placed many physicians in situations in which they feel conflicted regarding the care they are able to provide contrasted with the care they feel obligated to provide, but when hospital beds are not available, there are unavoidable limitations.

As discussed in Nursing Ethics, the ethically stressed situations faced by healthcare professionals resulting in moral injury can manifest as:

  • Feelings of guilt and regret
  • Judging oneself or one’s actions harshly
  • Emotional turmoil
  • Breach in the individual’s moral compass
  • Anxiety
  • Withdrawal from society

An article published by the American Medical Association recommends some steps to cope with moral injury and its symptoms. These include communicating with your fellow physicians about the circumstances contributing to moral injury, reconnecting with your calling, taking time to check in with yourself, and seeking support opportunities. If symptoms persist or get worse, seek medical attention.

The hope is that we are continuing a path toward a diminished pandemic. But even so, the stresses of managed care, billing challenges, and other obstacles to practicing medicine will always be there. Be aware of your wellness and ask for help when you need it.