Moral injury, not burnout?
It is convenient to describe what many doctors experience as burnout. But a heavy workload is not necessarily the problem. Doctors have always had a heavy workload, and it often starts before their medical studies. Nevertheless, the impression is that doctors increasingly feel that they are falling short in consultations with patients. They feel that they are not up to the mark and that the potential for making errors is increasing.
There is support for the notion that the sum of morally stressful events and moral distress can result in what we may call moral injury, including for healthcare workers (2). The concept of moral injury was introduced in 1994 and is based on committing, being witness to, being unable to prevent, or in some other way experiencing events that are at odds with one's own moral convictions and expectations (3). The primary symptom is a feeling of guilt. Other symptoms include excessive rumination on the event that triggered the feeling of guilt, as well as shame, existential conflict, loss of confidence in oneself or others, and a loss of meaning (4).
There is support for the notion that the sum of morally stressful events and moral distress can result in what we may call moral injury, including for healthcare workers
From our own research on mental health in healthcare workers in the ambulance and air ambulance service, we know that anomalies or incorrect treatment resulting in patient injury and accidents in ambulances are perceived as very emotionally stressful (5). For personnel in the air ambulance service, not being able to help seriously ill or injured patients was most traumatic for individuals (6). However, the prevalence of post-traumatic stress disorder, anxiety and depression among respondents in our surveys was no different from the general adult Norwegian population. We are not aware that the prevalence of moral distress or injury has been studied or demonstrated among Norwegian healthcare workers.