Closer Look
Opinion: Parsing moral injury and physician burnout
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Even though Wendy Dean and Simon Talbot clearly stated "this is not physician burnout" when they wrote about moral injury in their compelling STAT First Opinion in 2018, they've been fighting assumptions ever since about what such distress does involve. That essay led to a movement, a nonprofit organization, a podcast, and a book. Now Dean is back, writing another First Opinion about the betrayal at the heart of moral injury, making a distinction between short-staffing in health care that can drive burnout and the lack of response to repeated requests to increase staffing to safe levels that increases the risk for moral injury.
"Morally injurious situations that are inescapable may lead to the learned helplessness, cynicism, and detachment of burnout," Dean writes. "Correctly identifying drivers in ways that resonate with the workforce and developing targeted solutions could be the answer to retaining and sustaining a robust healthcare workforce." Read more.
mental health
Kids with anxiety more likely to get medication alone from their doctors
Even before the pandemic changed our lives, the prevalence of anxiety symptoms had been growing among children, adolescents, and young adults. A study out in Pediatrics today looks at how those symptoms, including persistent worries and fears, are being treated in primary care offices. Across three timeframes from 2006 through 2018, anxiety disorders were diagnosed more often, rising from 1.4% of visits to 4.2% in the latest period. The treatment changed, too, from just under half of children receiving psychotherapy to just below one-third of patients getting it.
Medication use stayed the same, but the likelihood of receiving medication alone grew. That means more patients overall were receiving either no treatment or only medication during the last period. The authors say this greater reliance on medications could be a sign of doctors' offices struggling to meet a mounting child and youth mental health crisis.
hospitals
Study finds disparities even at the safest hospitals
Some hospitals deliver better care than others, and that includes safety within their walls, ranging from falls, infections, and bedsores to complications like sepsis, hemorrhage, or blood clots after surgery. A new Leapfrog report builds on its assessment of hospital safety to ask if Black, white, and Hispanic patients received the same care at hospitals the nonprofit graded A (the best) for safety. For 10 million patients in 15 states in 2019, A-graded hospitals had the lowest rates of adverse safety events, as you might expect.
But Black patients had higher incidence of adverse safety events after surgery than white patients: sepsis (up 34%), blood clots (up 51%), and respiratory failure (up 17%). "In gaining access to a hospital with a higher Safety Grade, a Black patient has no assurance that the quality of care received relative to a white patient will be any better than lower-rated hospitals," the report concludes.
On the latest episode of the "First Opinion Podcast," First Opinion editor Torie Bosch speaks with Mass General Brigham's Sarah Wakeman about involuntary treatment for opioid use disorder. Listen here.
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