Burnout of clinicians is the wrong term, argue Dean et al. Instead they liken the phenomenon to “gaslighting” – the act of psychologically manipulating someone to question their own sanity, in order to gain some advantage.
We believe that clinicians are not burned out; instead, they are suffering moral injury. Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the healthcare context, this transgression is caused by the need to accomplish the impossible task of satisfying the patient, hospital, insurer, and ourselves all at once. Moral injury locates the source of the distress, appropriately, external to the physician and within the business framework of healthcare itself.
Healthcare systems have looked for easy fixes for physician distress, focusing on wellness (yoga, retreats, and self-care lessons), but this is misguided. Finding solutions requires that we address the problem for what it really is: a challenge inherent in the structure of the healthcare industry. Telling clinicians that they are “burned out” without acknowledging the cause of their distress is gaslighting.
Their earlier description of moral injury is here.
Accreditation does rely on gaslighting. Year by year, assessors ramp up allegations of potential incompetence and lack of “quality” if more and more records aren’t kept for them to inspect. Where’s the evidence that it’s true? Numbers, please. With calculations for uncertainty of measurement and trends. Why should the inspection gang get away with cosy assessments of each other?
Gaslighting has always been part of how inspectionism works. And it’s increased laboratory costs by a third.
ISO accreditation doesn’t feature in the article’s causes of “burnout” for this large group of US doctors who have little exposure to it. However, staff groups that live under it do experience similar effects from the demands of accreditors. Cognitive dissonance may never kick in since many staff fail to realize that accreditation is mostly a scam.
The feelings can also be mistaken for hypocrisy by those whose for whom accreditation has become central to their jobs. That’s only true if they’re extolling it rather than doing their jobs of complying. It’s the price for living in the parallel universe where accreditation does what it claims in spite of the increasing numbers of ISO-accredited disasters and deaths.
Professional bodies and top management get taken for a second ride: they say that marketing elements of eastern religions as commercialized personal worship hobbies provides a solution.
Mindfulness is not the solution.
Neither are the various brands of yoga.
These layers of gullibility show the organisations don’t know what they’re talking about.
No, the solution is to stop the ISO accreditation scam and various similar waste-generating bureaucracies.
Spend some of the money saved on a prize for anyone who identifies a difference.