Episode #503: Moral Injury — Interview with Wendy Dean, MD

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SHOW SUMMARY: Co-hosts Ron Baker and Ed Kless talk with Dr. Wendy Dean, author of If I Betray These Words. Dr. Dean, a psychiatrist and co-founder of the nonprofit Moral Injury of Healthcare, explores the profound ethical dilemmas faced by professionals today. Through the lens of her groundbreaking book, Dr. Dean discusses the concept of moral injury—the psychological distress that occurs when individuals feel unable to act according to their ethical and moral values. She shares real-life stories from the frontlines of healthcare, highlighting the emotional toll on professionals who are often caught between the demands of a healthcare system and their commitment to patient care. Ron and Ed pursue with her the idea that moral injury applies to professionals in other fields as well.

ABOUT DR. WENDY DEAN

Wendy Dean, MD is the CEO and co-founder of The Moral Injury of Healthcare, a nonprofit focused on alleviating workforce distress through research, education, consultation, and training. She is the author of, If I Betray These Words: Moral Injury In Medicine and Why It’s So Hard For Clinicians to Put Patients First, and cohost of the Moral Matters and 43cc podcasts. Before co-founding the nonprofit, Dr. Dean practiced as a psychiatrist, worked for the Department of Defense in research innovation, and as an executive for a large international non-profit supporting military medical research. Dr. Dean graduated from Smith College and the University of Massachusetts Medical School. She did her residency training at Dartmouth Hitchcock Medical Center in Lebanon, NH.

 
 

SHOW NOTES

Segment one

  • Ron’s favorite TV show is House, M.D. and he describes Dr. Dean as the “House” of moral injury. Her book, “If I Betray These Words” is at this link https://www.amazon.com/If-Betray-These-Words-Clinicians/dp/1586423541 

  • With respect to medicine Dr. Dean says, “The real reason that we went into this profession was to take care of people at their most vulnerable, without self interest.”

  • “We people have been doing really intensive studies and important work in this field. We still have 40% of our clinicians who feel burned out because that's the language that we use. If that's the case, maybe we should reconsider what we're treating.” —Dr. Wendy Dean

  • So what is the definition of moral injury? Jonathan Shay was the first one who defined it in 1990s, and he said it was betrayal by a legitimate authority in a high stakes situation.

Segment two

  • Burnout is traditionally defined as sort of a demand resource mismatch. Moral injury is more of a qualitative challenge…a relational rupture based on betrayal (unintentional in most cases).

  • On the professional services side, here is a great example of moral injury: You know that you should be working to a certain standard and you're being asked to lower that standard because someone inappropriately bid on the job. 

  • “90% of leadership books are all about how do we deal with the five crucial conversations. It’s transactional. The reality is that the anxiety is more chronic.” —Ed Kless

  • “There's this great term that I just learned called care washing which focuses on the superficial level of our distress. What we are really asking for is that we actually start doing the hard work of changing the underlying system.” —Dr. Wendy Dean (paraphrased)

Segment three

  • Ed mentioned this article during segment three: “How American Health Care Killed My Father” https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ 

  • “We can renovate this house of health care but in order to do it in the most efficient way possible, we need to have the blueprint, which is why I wrote the book and it's why I wrote it in the way I did, which is not only to tell to lay out where we are but how we got here.” —Dr. Wendy Dean 

  • Wow! There are only a million physicians in the US. There are only 3 million nurses. There are 330 million patients.

  • “Physicians can't keep practicing like this and feel like they they are maintaining that oath and their integrity.” —Dr. Wendy Dean

Segment four

  • From Wendy today on healthcare reform: 1) We need to decouple it from our employers. 2) We need to move from having it be care for everything to catastrophic care. 3) Wellness and preventative care should be in a different bucket of money. 

  • This is a GREAT quote from Wendy today on the show by way of Jerry Moeller, “Everything that we measure doesn't matter.”

  • Ed read a great quote on the show today that came out of Disney parks, “It's okay to be off task, as long as you're on purpose.”

  • A big THANK YOU to Dr. Wendy Dean for joining us today. Please, please, PLEASE check out her amazing book “If I Betray These Words” on Amazon https://www.amazon.com/If-Betray-These-Words-Clinicians/dp/1586423541 

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