Physician burnout: moral injury is a questionable term

I think that use of the term “moral injury” in medicine1 is highly inappropriate, as explained in an upcoming publication and briefly summarised below.2

The concept of moral injury, poignant as a psychoemotional impact of war, is misplaced when applied to the practice of medicine. Suggesting equivalence between the experience of warriors and the (very real) stresses of medicine is naïve and is demeaning to those who defend their countries.

Years of extensive research on burnout indicate that it is a construct of some value. Moral distress in medicine is recognised.3 But moral injury in medicine is not well operationalised or researched, nor is the prevalence known.

Proponents of moral injury usually assert other dubious corollaries, which were represented in The BMJ’s article.1 The term burnout doesn’t blame physicians or absolve healthcare systems of responsibilities. Additionally, the discussion of individual approaches to enhancing resilience often has a perplexing condescending tone, including the mistaken belief that resilience cannot be taught or developed. Multiple examples of effective resilience training exist in other mission critical domains (military, police, firefighting). Many doctors can benefit from individual resilience techniques.

Introducing questionable terminology obfuscates the need to develop strategies to prevent and mitigate physician distress at both the individual and system levels. This tendency can lead to more confusing nomenclature, such as suggesting that moral injury be supplanted by “human rights violations.”4

I am not arguing unequivocal support for the term burnout, as there are legitimate questions about its nature.5 But I am arguing that, blending the title of a popular movie with the title of this column, the term moral injury in medicine should be gone in 60 seconds.