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Archive ORX Session Previews 2019

It's Moral Injury, Not Burnout

Wendy Dean

Wendy Dean, MD


Last year, psychiatrist Wendy Dean, MD, and reconstructive plastic surgeon Simon Talbot, MD, published an article in STAT titled "Physicians aren't "burning out.' They're suffering from moral injury" ( Let's say it struck a chord.

"We didn't know if this would make any sense to anyone else, but it made sense to us," says Dr. Dean. "We put it out there, and were shocked by the response we received" — to the tune of almost 250,000 article downloads and millions of related video views on the subject. "People said, "This is the language I've been looking for to describe how I feel,'" she says. "It explains very clearly the struggle that healthcare providers deal with every day."

What is moral injury? It's feeling overwhelmed, demoralized, exhausted, alone. Dr. Dean says the concept came into being as Vietnam War veterans returned home and were treated for PTSD. Practitioners found that in some cases their treatments for PTSD weren't working. "They realized something else was at play," she says. Moral injury was coined.

"For healthcare providers, moral injury isn't about a combat situation," says Dr. Dean. "It's about the moral tension between what we've vowed to do — take care of patients — and the reality of what we can do within the constraints of the current healthcare system. It's the constant fight against double binds, where no matter what you do, you can't win. It's not your fault. It's the result of working in a system that's in crisis. We need to get back to making sure our patient is truly the priority, and to recognizing the value of the provider at each stage of the patient's care."

At OR Excellence, Dr. Dean will discuss the moral injury phenomenon and elaborate on 3 key aspects of moral injury:

  • How to identify the situations that cause moral injury.
  • The importance of protecting the provider-patient relationship.
  • Recreating a strong provider community in health care.

Moral injury and burnout can seem similar on first glance, but there are important distinctions. Burnout is often assumed to result from an individual's insufficient coping skills. Moral injury, on the other hand, is a systems problem, resulting from multiple competing allegiances.

"Providers may have some of the symptoms of "burnout' — depersonalization, a low sense of accomplishment or disengagement," says Dr. Dean. "They're told they need to take better care of themselves, do yoga, participate in wellness programs, but what they really need are fewer situations in which their ability to care for patients is frustrated by the business framework of health care." OSM

Speaker Profile

  • In addition to being the co-founder of Moral Injury (, Dr. Dean is senior vice president of program operations with The Henry M. Jackson Foundation for the Advancement of Military Medicine in Bethesda, Md.
  • A private practice psychiatrist from 2000 to 2010, she left clinical medicine when generating revenue crowded out the patient-centered priorities in her practice.
  • She worked for the U.S. Army in product development for regenerative medicine technologies from 2010 to 2018, and is considered an expert in the field of hand and face transplants.
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