I didn’t even realize how broken I was, until I saw myself reflected in this article: “Physicians aren’t ‘burning out’. They’re suffering from moral injury,” said the title.
A few paragraphs in, and suddenly I was weeping.
Oh my God, that’s ME!
I had been struggling against the fury that simmered in my belly, battling the guilt that ate a little piece of my soul every time a patient received inappropriate or inadequate care because their healthcare decisions were being made by an anonymous link in the chain of a massive private equity firm, beholden only to the bottom line. Shame flushed my cheeks and made my hair tingle when I finally understood that the MD after my name meant only that I knew what the right thing was for a patient, it no longer granted me the power to provide it.
The article had been published in 2018, but I wasn’t familiar with the term moral injury yet, didn’t know that it was rooted in the experiences of military personnel. That when soldiers came home from Vietnam, many of them were diagnosed with post-traumatic stress disorder, but that this missed a crucial piece — because while both stem from trauma, and there is much overlap in symptoms and sequelae, moral injury speaks to the wounds inflicted by dehumanization and disempowerment, rather than by mortars and bullets.
Those invisible wounds inflicted on a person’s soul when they are forced to witness, perpetrate, or withhold aid in the face of acts that violate their personal ethical and/or moral framework, are both profound and devastating.
This was new for me, the disempowerment. I had spent most of my career shielded from the creeping corporatization of healthcare. In fact, I had unwittingly contributed to it myself, when I agreed to the sale of the hospitalist company I had helped to create and grow. We built it on a foundation of patient-centered care, meaningful partnership with the staff and administrators of the hospitals we served, and a commitment to our community, including our team. It was a labor of love, and I was deeply proud of the excellent care we delivered to our patients and their families, of the contributions we made. The bar we set.
I didn’t know then, that the company which bought it would go on to be bought by an even larger company, which would in turn be gobbled up by a behemoth. I didn’t know then, that the very things which made it thrive would be promptly destroyed, the magic smothered. That it would be dismantled and essentially sold for parts, in the vein of a widget factory after a hostile takeover.
Neither did I know, that the proceeds would turn out to be a life raft for my family when my husband died and I had to shift my focus from healing patients to healing my two young sons. It was the reason I was able to hold my family together in the face of unimaginable grief, to focus entirely on keeping my children in orbit. It gave us the time we needed, to find our feet again. So it turns out, I was part of the problem. I personally benefited from it. Talk about cognitive dissonance.
After several years away from clinical practice, my children were ready for me to go back to work, “It’s okay Mom,” they said, “we can handle it. You should go help other people now, it’ll be good for you.” So I did, or at least, I tried. But what I found broke my heart. A stark landscape, ruled by cynicism and greed. A workforce battered and bruised, demoralized and disrespected, exploited and gaslit. What I found, was a system devouring that on which its very existence depends.
Ultimately, I rage-quit the job that had become untenable. That pushed me to the outer edges of myself, forced me to question the very premise of my chosen field, morphed me into an unrecognizable avatar. I was shattered. Thrust into an existential crisis. A cataclysm powerful enough to sap my patience with my children, distance me from a partner when he needed me, and leave me grappling with the knowledge that I was just a teeny-tiny cog in a monstrous machine. It was brutal.
And what could one teeny-tiny cog possibly do about it?
My late husband JJ used to roll his eyes when people would say, with a smidge of toxic positivity, “Well… everything happens for a reason!”
He would just smile with the patience of the cancer patient, experienced in fielding the discomfort of others, “Well… I’d say shit just happens. And it’s up to us to decide what we do with it. It’s our choices, that give it a reason.”
It was with his voice in my ear, You can’t control what happens around you, Doll. But you have absolute control over what you make of it, that I dove into researching what we were actually doing to help our healers navigate this fraught environment. Because the daily emails I received from my employer exhorting me to exercise or do some yoga or get more sleep were profoundly unhelpful, and smacked of victim-blaming. I didn’t need lessons in self-care or resilience, how did they think I survived medical school and residency and years of practice? It was not a question of finding the right herbal tea, FFS.
Clearly, the medical-industrial complex will not be changing its direction any time soon. We can only hope that as a society, we recognize that the very foundation of our healthcare system is cracked, before it crumbles beyond repair. Because when the equivalent of two whole medical school classes are driven to commit suicide every year, we are all at risk.
People are not, after all, widgets. And the guiding principle of Corporate America, as inspired by economist Milton Friedman’s 1970 essay “The Social Responsibility of Business Is to Increase Its Profits” simply does not apply to human beings. At least not in any civilized society. Ironically, Friedman himself pointed out the difference between a hospital and a widget factory in the very essay that legitimized the era of corporate greed:
“A group of persons might establish a corporation for an eleemosynary purpose—for example, a hospital or school. The manager of such a corporation will not have money profit as his objective but the rendering of certain services.”
That last bit seems to have gotten lost along the way.
My inner nerd dove into the data, because acquiescence is not an option — if we give up, all is lost. And I found, to my surprise, one intervention that actually proved efficacious in decreasing burnout and moral injury among healthcare workers: Professional coaching.
I’ll admit I was skeptical at first. I mean, wasn’t “life coaching” kind of a nebulous concept, the purview of astrologers and mystics and such? But as I read on, the data told me otherwise. The data told me that physician-coaching decreases burnout and emotional exhaustion, that it improves self-valuation and professional fulfillment, that it increases engagement. The data shows that it actually — helps.
Here are a few articles, in case your own inner nerd is curious:
Physician Coaching by Professionally Trained Peers for Burnout and Well-Being
Physician Burnout: Coaching a Way Out
Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians
Employer-Provided Professional Coaching to Improve Self-compassion and Burnout in Physicians
So this was how I would create a reason from the embers of my meltdown. I might not have the power to change the medical-industrial complex, but I have the power to change my relationship to it. My experience of it. Through coaching, I amassed the tools I needed to reclaim myself. To recapture my joy. To clarify my path forward with intention and purpose. And as a coach now myself, it is my mission to do my part to help heal our healers.
After all, even a teeny-tiny cog contributes to the whole — for better or for worse.
I choose better.
As a certified professional coach, I am thrilled to be partnering with Joy Point Solutions in offering personal-professional development coaching, with a passion for healthcare workers. Here is a snippet from an interview about the power of coaching:
If any of this resonates with you, please connect with us at:
Or, feel free to contact me directly at sara@joypointsolutions.com, if you’d like to schedule a consult call.
Beautifully written, as always. You’ve got ALL the chops and are poised to help alleviate a lot of suffering and moral injury.