Clarifying the Language of Clinician Distress

Abstract

Neurasthenia was once a diagnosis ubiquitous enough to be household vernacular, but by the 1930s, as physicians became interested in more precise, narrower diagnoses, fewer patients were diagnosed as having this condition. 1 The widespread use of the diagnosis had diluted its utility. In 2019, member states of the World Health Organization accepted the International Classification of Diseases and Related Health Problems, Eleventh Revision, which retired neurasthenia, and replaced this term with bodily distress disorder. 2 Today, it is possible that the term burnout may be approaching, and perhaps should have, the same fate. The use of burnout to describe current occupationally related issues (such as stress, frustration, dissatisfaction, and depression) affecting physicians and other health practitioners has become widespread. Challenges with accurately identifying and measuring a subjectively assessed constellation of symptoms are interfering with efforts to quantify and address widespread clinician distress. 3,4 Shifting the language of distress to incorporate etiology could potentially allow better assessment and more targeted solutions to the crisis.

Moral Distress During COVID‐19: Residents in Training Are at High Risk

“…11 Repeated episodes of moral distress in the workplace cause clinicians to become isolated 15 and morally numb to challenging situations, develop a loss of moral identity, and finally succumb to moral injury, where a physician begins to question their own moral framework for continuing to work within the system. 6,16 Studies of both clinicians and nurses find that moral distress cases cause frustration, anger, guilt, anxiety, depersonalization of patients, and finally a high risk for burnout and leaving the profession. 6,[17][18][19][20] With the COVID pandemic in mind, the surge of patients in certain hotspots and the inability of the physician and nurse workforce to keep up with demand, as well as a clinician's fear for his or her own health, is anxiety provoking for all health care providers.…”

“…6,16 Studies of both clinicians and nurses find that moral distress cases cause frustration, anger, guilt, anxiety, depersonalization of patients, and finally a high risk for burnout and leaving the profession. 6,[17][18][19][20] With the COVID pandemic in mind, the surge of patients in certain hotspots and the inability of the physician and nurse workforce to keep up with demand, as well as a clinician's fear for his or her own health, is anxiety provoking for all health care providers. There are things program directors can do, however, to help residents manage this tension and mitigate moral injury.…”

“…“Moral distress” is a phrase Jameton 5,6 coined in 1984 to describe the psychological reaction to situations where the individual knows what is morally right, but is unable to act accordingly because of institutional or other constraints. Most research on moral distress in medicine originates from nursing literature.…”

“…Repeated episodes of moral distress in the workplace cause clinicians to become isolated 15 and morally numb to challenging situations, develop a loss of moral identity, and finally succumb to moral injury, where a physician begins to question their own moral framework for continuing to work within the system 6,16 . Studies of both clinicians and nurses find that moral distress cases cause frustration, anger, guilt, anxiety, depersonalization of patients, and finally a high risk for burnout and leaving the profession 6,17–20 …”

Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study

“…These are situations in which the individual is faced with two moral principles, in opposition to each other, which imply making a decision: maximizing the common good according to a cost-benefit analysis (utilitarian resolution) or deciding for the unconditional respect for a moral rule, regardless of the consequences (deontological resolution). Moral distress occurs when individuals know what is the ethically appropriate choice but they are unable to do it due to external or internal restrictions (McCarthy and Deady, 2008;Epstein and Hamric, 2009;Dean et al, 2020;Dunham et al, 2020). During an emergency like a pandemic, some decisions are made under stress and several studies showed that stress can influence moral decision-making (Lützen et al, 2010;Starcke et al, 2011;Starcke and Brand, 2012;Youssef et al, 2012;Romero-Rivas and Rodríguez-Cuadrado, 2020).…”