May 14, 2019

I recently spent time at the Massachusetts Medical Society annual meeting in Boston. As I am originally from Massachusetts, and did my undergrad, medical school and residency in Massachusetts, it was great to see many of my prior classmates and colleagues that I have not seen in years.

I also enjoyed the discussions at the ethics forum and educational session at the Mass Med Society meeting. The ethics forum discussed value-based care and some of the inconsistencies that exist in this country’s health care system and how we are currently providing care. The discussion focused on the need to change from an outcomes focus and the need to harness the internal motivation of physicians to do the right thing. Physicians do not need motivation to screen patients for diseases that are preventable by early detection (as physicians will do this regardless of the incentive) but the focus should change to incentives for the health and wellbeing of patients with the development of better quality measures not the same measures as 1995, that were not good then and are not good now.

The educational session was focused on physician burnout and moral injury. I was initially thinking, "Here we go - another lecture to tell me to relax and meditate." Well, I was pleasantly surprised – especially when the speaker said “telling physicians to meditate is not the answer!” The speakers focused on providing physicians with a better work environment. A few examples given resonated with me. A stronger worker is not the issue. Construction workers are given hard hats. They are not expected to have stronger skulls. And to prevent back injuries, most patient care areas now have lifts to move patients. 

What are organizations doing to protect physicians from moral injury? In order to achieve this there are three aspects that need to come together – an organizational culture of wellness, efficiency of practice and personal resilience to lead to professional fulfillment. The majority of the energy needs to be focused on the organizational culture and efficiency of practice and less on personal resilience, as this is not an area affecting just a few physicians but the majority of physicians. 

I was happy to hear discussions with new and different ways of addressing the continuing issues facing physicians. 

Tessa Lafortune-Greenberg, MD
NHMS President

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