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Dr Florian Honeyball
Moral injury, which has become part of the lexicon during the COVID-19 pandemic, is probably misclassified as burnout in some healthcare workers, an Australian specialist says.
Dr Florian Honeyball, a medical oncologist at the Dubbo Base Hospital in regional NSW, argues that some of the methods of dealing with burnout, such as resilience development and stress management, may actually worsen the situation for people affected by moral injury.
He told the MOGA 2022 annual meeting the three components of moral injury, as conceptualised by US psychiatrist Dr Jonathon Shay in regards to veterans, were:
- A betrayal of what was morally right
- Perpetrated by someone who holds legitimate authority
- Delivered in very high stakes situations.
“How that translates into healthcare is that inability to treat our patients well to our personal gold standards.”
He gave the example of sending someone home from hospital due to time pressures and a lack of beds while knowing they possibly required more care.
Factors including patient load, lack of reimbursement for some drugs, temporal obligations such as EMR and governance issues, and a system-wide focus on efficiency and financial metrics, created the environment for moral injury to occur.
“There’s an increasingly litigious society so sometimes we feel like second guessing ourselves and maybe overinvestigating where we probably wouldn‘t have otherwise,” he added.
Dr Honeyball said the constellation of symptoms in moral injury included shame, guilt, irritability, anger, embarrassment, anxiety, and feelings of worthlessness.
And while symptoms such as fatigue and negativism could overlap with burnout symptoms, there was a slight difference.