Surveys of physicians show that burgeoning government regulations is one reason for burnout

See ‘If I Betray These Words’ Review: First, Do No Harm by Aaron Rothstein. He is a neurologist and fellow in bioethics and American democracy at the Ethics and Public Policy Center in Washington, D.C. He revies the book “If I Betray These Words: Moral Injury in Medicine and Why It’s So Hard for Clinicians to Put Patients First" by Wendy Dean and Simon Talbot. Excerpts:

"How did this happen? Each chapter and story emphasizes a similar conclusion: “No matter how [physicians] respond, they are all victims of a profit-generating machine that has taken over healthcare.” Profit and nonprofit hospitals, “motivated largely by revenue,” cut staff, increase physician work hours, hijack physician autonomy and silence any dissent with threats of termination. Caught between the oaths they took as medical students and the crushing pressures of corporate healthcare, doctors suffer moral injury.

While the authors identify an important concern—that current profit-seeking behavior stymies physicians and patients—such au courant criticisms of capitalism are incomplete in explaining moral injury. Profit motives in medicine have existed for decades and will likely always exist to a certain degree. In 1894 an editorial in the journal Medical Record argued that doctors saw hospital growth “critically, not to say coldly,” and resented the motive of hospitals to “get as much out of them with as little return as possible.”

Today, surveys of physicians provide a more comprehensive story. They identify other factors, some of which are mentioned by Drs. Dean and Talbot, as sources of moral injury: increased bureaucracy, lack of respect from staff, lack of respect from patients, and burgeoning government regulations. Not all of this relates to corporate greed; for instance, bureaucracy is always a side effect of government regulation. Indeed, our modern medical system now paradoxically combines the worst excesses of socialism (bureaucracy) and capitalism (greed). This contradictory yet sinewy co-existence is ultimately responsible for physician burnout. And it can only exist in a cultural environment confused about medicine’s purpose."