The moral distress syndrome affecting physicians: how current healthcare is putting doctors and patients at risk

233 Pages·10.948 MB·English

by  Facs, Eldo E Frezza MD Mba

The Moral Distress
Syndrome Affecting
Physicians

The Moral Distress
Syndrome Affecting
Physicians
How Current Healthcare Is Putting
Doctors and Patients at Risk
Eldo E. Frezza, MD, MBA, FACS
First published 2021
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 Taylor & Francis
The right of Eldo E. Frezza to be identified as author of this work has been asserted by him in
accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
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are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Names: Frezza, Eldo E., author.
Title: The moral distress syndrome affecting physicians : how current
healthcare is putting doctors and patients at risk / Eldo E. Frezza.
Description: New York, NY : Routledge, 2021. | Includes bibliographical
references and index.
Identifiers: LCCN 2020012901 (print) | LCCN 2020012902 (ebook) | ISBN
9780367473044 (hardback) | ISBN 9780367471538 (paperback) | ISBN
9781003034766 (ebook)
Subjects: MESH: Physicians--psychology | Burnout, Professional--psychology
| Psychological Distress
Classification: LCC R690 (print) | LCC R690 (ebook) | NLM WA 495 | DDC
158.7/23--dc23
LC record available at https://lccn.loc.gov/2020012901
LC ebook record available at https://lccn.loc.gov/2020012902
ISBN: 978-0-367-47304-4 (hbk)
ISBN: 978-0-367-47153-8 (pbk)
ISBN: 978-1-003-03476-6 (ebk)
Typeset in Garamond
by Deanta Global Publishing Services, Chennai, India
To all the physicians who are suffering
in silence and in the dark.
To all involved in healthcare systems who are
forgetting that physicians are their customers.
Satisfied physicians produce satisfied patients.
To my children Edoardo and Gianmarco, who
have witnessed a lot in their young age.

Contents
About the Author ...............................................................xv
Why Write This Book? ....................................................xvii
What Is Moral Distress? ...................................................xxi
SeCtion 1 tHe iSSUeS FUeLinG
MoRAL DiStReSS SYnDRoMe
1 Two Old Friends ......................................................3
1.1 Definition of Moral Distress .......................................6
Reference .............................................................................7
Suggested Reading ..............................................................7
2 The Grand Round Lecture .......................................9
2.1 Moral Distress Syndrome ...........................................9
2.2 Moral Pain ..................................................................11
2.3 Moral Injury ...............................................................13
2.4 Moral Distress ............................................................13
References ..........................................................................14
3 Litigation Syndrome ..............................................17
3.1 Definition and Symptoms of Litigation Syndrome ......17
3.2 Burnout and Suicide ..................................................18
3.3 Emotional Detachment ..............................................19
References ..........................................................................20
Suggested Reading .............................................................20
vii
viii ◾ Contents
4 Burnout ..................................................................23
4.1 Causes of Burnout .....................................................23
4.2 Side Effects of Burnout ............................................24
4.3 Suicide and PTSD ......................................................24
4.4 Depression Symptoms Even in Medical Students ....26
4.5 Must Be Healthy to Get Licensures ..........................27
References .........................................................................28
Suggested Reading .............................................................29
5 Suicide: From Medical Student, to Resident, to
Clinician .................................................................31
5.1 Risk of Suicide in Physicians .....................................31
5.2 Stress Factors and Side Effects ..................................32
5.3 Suicide in the USA .....................................................33
5.4 Lack of Policies ..........................................................34
References ..........................................................................36
Suggested Reading .............................................................36
6 Why Have Physicians Suffered a Lack of
Recognition? ..........................................................37
6.1 Stressful Profession ....................................................37
6.2 Lack of Satisfaction ....................................................38
6.3 Lack of Recognition ...................................................39
6.4 Physicians Are at Risk ...............................................40
6.5 Fear of Losing the License ........................................41
References ..........................................................................42
Suggested Reading .............................................................43
7 Can Malpractice Claims Create Permanent Injury? ....45
7.1 Aggressive Environment to Work In .........................45
7.2 Distress of a Lawsuit ................................................ 46
7.3 Guilty till Proven Innocent .......................................47
7.4 Communicate with Patients .....................................48
References ..........................................................................50
Suggested Reading ...........................................................50
8 Why Is Medicine Burning Out Physicians?............51
8.1 Financial Pressures ....................................................51
Contents ◾ ix
8.2 Hamster in a Wheel ..................................................52
8.3 Lack of Respect toward Physicians ...........................53
Suggested Reading .............................................................56
9 Broken Systems and Culture .................................57
9.1 Corporate Culture ......................................................57
9.2 Increasing Denial of Insurance Services ..................59
9.3 Refusing Clinical Evidence ........................................60
9.4 Locum Company Cartels ...........................................62
Suggested Reading .............................................................63
10 Physicians Leaving Medicine .................................65
10.1 Lost Goals ..................................................................65
10.2 Medicine Is an Art, Not Just a Business ...................67
References .........................................................................68
11 Impossible Victory: Physicians Are the New
Chain Worker .........................................................69
11.1 Managers Who Lack Clinical Training .....................69
11.2 Managers and Physicians Have Opposing Aims ......71
11.3 Medicine Is Not a Cook Book ..................................72
Suggested Reading .............................................................73
12 Emotional Trauma: Brain Zapping and
Concussion .............................................................75
12.1 Emotional Trauma .....................................................75
12.2 The Similar Symptoms of Concussion and Moral
Distress ......................................................................76
12.3 Brain Zapping ...........................................................77
Suggested Reading .............................................................79
13 Divorce among Physicians .....................................81
13.1 Physician Divorce Study ............................................81
13.2 Specialty Traits ...........................................................82
13.3 Divorce in the USA ...................................................84
13.4 Average First Marriage Duration ...............................85
13.5 Cost for the Taxpayers ..............................................87
References ..........................................................................87
Suggested Reading ............................................................88