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If I Betray These Words: Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First
Through stories and solutions, leading physicians tackle the conundrum of how best to care for patients while being thwarted by the business side of healthcare
Moves "away from calling doctors’ difficulties 'burnout'—thus blaming doctors—to 'moral injury'—like soldiers floundering under unjust orders. A brilliant expansive book.”—Samuel Shem, Professor in Medicine at NYU Medical School, author of The House of God and Man's 4th Best Hospital
“Wendy Dean diagnoses the dangerous state of our healthcare system, illustrating the thumbscrews applied to medical professionals by their corporate overlords… Required reading for all stakeholders in healthcare.”—Danielle Ofri, MD, PhD, author of When We Do Harm; A Doctor Confronts Medical Error
Offering examples of how to make medicine better for the healers and those they serve, If I Betray These Words profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.
Doctors face real risks when they stand up for their patients and their oath; they may lose their license, their livelihood, and for some, even their lives.
There’s a growing sense, referred to as moral injury, that doctors have their hands tied—they know what patients need but can’t get it for them because of constraints imposed by healthcare systems run like big businesses.
Workforce distress in healthcare—moral injury—was a crisis long before the COVID-19 pandemic, but COVID highlighted the vulnerabilities in our healthcare systems and made it impossible to ignore the distress, with 1 in 5 American healthcare workers leaving the profession since 2020, and up to 47% of U.S. healthcare workers now planning to leave their positions by 2025.
If I Betray These Words confronts the threat and broken promises of moral injury—what it is; where it comes from; how it manifests; and who’s fighting back against it. We need better healthcare—for patients and for the workforce. It’s time to act.
Moves "away from calling doctors’ difficulties 'burnout'—thus blaming doctors—to 'moral injury'—like soldiers floundering under unjust orders. A brilliant expansive book.”—Samuel Shem, Professor in Medicine at NYU Medical School, author of The House of God and Man's 4th Best Hospital
“Wendy Dean diagnoses the dangerous state of our healthcare system, illustrating the thumbscrews applied to medical professionals by their corporate overlords… Required reading for all stakeholders in healthcare.”—Danielle Ofri, MD, PhD, author of When We Do Harm; A Doctor Confronts Medical Error
Offering examples of how to make medicine better for the healers and those they serve, If I Betray These Words profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.
Doctors face real risks when they stand up for their patients and their oath; they may lose their license, their livelihood, and for some, even their lives.
There’s a growing sense, referred to as moral injury, that doctors have their hands tied—they know what patients need but can’t get it for them because of constraints imposed by healthcare systems run like big businesses.
Workforce distress in healthcare—moral injury—was a crisis long before the COVID-19 pandemic, but COVID highlighted the vulnerabilities in our healthcare systems and made it impossible to ignore the distress, with 1 in 5 American healthcare workers leaving the profession since 2020, and up to 47% of U.S. healthcare workers now planning to leave their positions by 2025.
If I Betray These Words confronts the threat and broken promises of moral injury—what it is; where it comes from; how it manifests; and who’s fighting back against it. We need better healthcare—for patients and for the workforce. It’s time to act.
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Published April 4, 2023
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Displaying 1 - 30 of 62 reviews
June 15, 2023
I picked up this ARC several months ago because my wife, who's an MD, had an advance copy and kept sending me screenshots tagged THIS!!!! Also, I'm a frequent flyer as a patient, so I kind of have a ringside seat to the issues as seen from both sides of the EMR screen. When I got the ARC I realized what I should already have known: this was going to be some seriously painful reading. It's not a long book, but it took me months.
Moral injury in healthcare might be most familiar to non-healthcare professionals from the worst days of the pandemic, when it was discussed with respect to the misery of not knowing how to take proper care of desperately ill people. Medical people in general want to help, and when they can't help they feel like failures.
The moral injury described in If I Betray These Words is inflicted by, in a word, capitalism. The for-profit entities that now control a large percentage of hospitals and medical practices and thus employ a large percentage of docs and nurses are far, far more interested in maximizing shareholder profit than they are in making it possible for healthcare workers to help their patients. Docs are allotted 15 or 20 minutes per appointment, and never mind if, for example (like my wife), they're managing cancer pain, which also entails addressing their patients' emotional state and that of their families.
If you're inclined to scoff at the idea that a doc who makes a lot of money might be suffering and deserve compassion, consider this: doctors commit suicide at twice the rate as the general population. For-profit healthcare is why.
I have been fairly fortunate in my doctors and surgeons, for many reasons. (None of which have to do with referrals from my wife, by the way; race and class privilege, education, and living in NYC have everything to do with it.) But I can see those doctors struggling. My neurosurgeon is kind and funny as well as very good at not paralyzing me while he's dicking around next to my spinal cord, but at every visit the initial intake is done by his (also lovely) NP, because docs are set a quota of daily appointments and to meet it they have to break pieces off each one. A third person checks my temperature and blood pressure. A fourth draws blood.
Where If I Betray These Words stumbles is in being liberal rather than radical. The trouble starts with the authors' frequent references to a halcyon past in which doctors could show patients all the kindness and care they wanted to. LOL. For starters, fifty years ago I wouldn't have dared to tell any of my doctors that I'm queer. But also, what a weird obliviousness to the history of medicine as an institution! You know why we don't have universal healthcare in the US? Harry Truman proposed it. The American Medical Association lobbied against it. The AMA won. The AMA also opposed Medicare. And (a little racist icing on this ugly cake), until 1968 the AMA admitted only white doctors.
Another stumble is in the focus exclusively on doctors. In one respect, this makes sense -- the authors are doctors, and some of the sources of moral injury are specific to them. But overall this framing leaves an impression that other HCWs -- nurses, especially -- aren't suffering just as much, being trapped in the same for-profit system.
There you have the whole problem. Dean and Talbot propose a number of improvements to the system: limit consolidation and vertical integration of healthcare systems; "choose our elected officials carefully" (have they not noticed the damage done to voting rights in the past decade?); make insurance more transparent; ditch prior authorization; ease up on documentation requirements. (This last might seem counterintuitive wrt patient safety, but ask yourself how much of your last visit your doctor spent looking at the screen instead of you. Also, be aware that the doc is probably spending at least another full workday's worth of hours on EMR every week besides what you're seeing.)
Well, you can see what's missing. All those proposals are fine, as far as they go, but they're nibbling at the edges. Every single doctor I know socially, and I know a lot of them, wants nothing more than to take good care of people. (Yes, yes, sampling error. Nevertheless.) But as long as our healthcare system functions on the basis of profit, they're not going to fulfill that wish. That's the elephant in the room, and Dean and Talbot describe it in great detail while still, somehow, managing to not quite see it.
Thanks to NetGalley and Steerforth for the ARC.
Moral injury in healthcare might be most familiar to non-healthcare professionals from the worst days of the pandemic, when it was discussed with respect to the misery of not knowing how to take proper care of desperately ill people. Medical people in general want to help, and when they can't help they feel like failures.
The moral injury described in If I Betray These Words is inflicted by, in a word, capitalism. The for-profit entities that now control a large percentage of hospitals and medical practices and thus employ a large percentage of docs and nurses are far, far more interested in maximizing shareholder profit than they are in making it possible for healthcare workers to help their patients. Docs are allotted 15 or 20 minutes per appointment, and never mind if, for example (like my wife), they're managing cancer pain, which also entails addressing their patients' emotional state and that of their families.
If you're inclined to scoff at the idea that a doc who makes a lot of money might be suffering and deserve compassion, consider this: doctors commit suicide at twice the rate as the general population. For-profit healthcare is why.
I have been fairly fortunate in my doctors and surgeons, for many reasons. (None of which have to do with referrals from my wife, by the way; race and class privilege, education, and living in NYC have everything to do with it.) But I can see those doctors struggling. My neurosurgeon is kind and funny as well as very good at not paralyzing me while he's dicking around next to my spinal cord, but at every visit the initial intake is done by his (also lovely) NP, because docs are set a quota of daily appointments and to meet it they have to break pieces off each one. A third person checks my temperature and blood pressure. A fourth draws blood.
Where If I Betray These Words stumbles is in being liberal rather than radical. The trouble starts with the authors' frequent references to a halcyon past in which doctors could show patients all the kindness and care they wanted to. LOL. For starters, fifty years ago I wouldn't have dared to tell any of my doctors that I'm queer. But also, what a weird obliviousness to the history of medicine as an institution! You know why we don't have universal healthcare in the US? Harry Truman proposed it. The American Medical Association lobbied against it. The AMA won. The AMA also opposed Medicare. And (a little racist icing on this ugly cake), until 1968 the AMA admitted only white doctors.
Another stumble is in the focus exclusively on doctors. In one respect, this makes sense -- the authors are doctors, and some of the sources of moral injury are specific to them. But overall this framing leaves an impression that other HCWs -- nurses, especially -- aren't suffering just as much, being trapped in the same for-profit system.
There you have the whole problem. Dean and Talbot propose a number of improvements to the system: limit consolidation and vertical integration of healthcare systems; "choose our elected officials carefully" (have they not noticed the damage done to voting rights in the past decade?); make insurance more transparent; ditch prior authorization; ease up on documentation requirements. (This last might seem counterintuitive wrt patient safety, but ask yourself how much of your last visit your doctor spent looking at the screen instead of you. Also, be aware that the doc is probably spending at least another full workday's worth of hours on EMR every week besides what you're seeing.)
Well, you can see what's missing. All those proposals are fine, as far as they go, but they're nibbling at the edges. Every single doctor I know socially, and I know a lot of them, wants nothing more than to take good care of people. (Yes, yes, sampling error. Nevertheless.) But as long as our healthcare system functions on the basis of profit, they're not going to fulfill that wish. That's the elephant in the room, and Dean and Talbot describe it in great detail while still, somehow, managing to not quite see it.
Thanks to NetGalley and Steerforth for the ARC.
May 14, 2024
I learned so much from this book about moral injury in medicine and the financial incentives behind many administrative decisions in healthcare. I was shocked and appalled by most of what was uncovered in this book, and the research that went into this was extensive. I appreciated getting a new physician’s perspective across specialties in each chapter about their experiences and how they handled moral injury. I did disagree with some of the ideas in the EMR chapter specifically but overall appreciated this perspective and the work of all the physicians in this book. The first half was pretty gloomy and hopeless but it ended well with some hope and a call to action.
February 14, 2023
I received a free copy of, If I Betray These Words, by Wendy Dean, Simon Talbot, from the publisher and Netgalley in exchange for an honest review. It is not an easy profession being a doctor, all the training, med school, al the bills. Some hospitals make it really tough to treat patients, when all they see is profit, when you set a time limit for each patient so you can see as many patients as you can in a day/week/month, use can and may miss diagnosis. A really good read, I enjoyed it, though its a tough subject.
April 20, 2023
It’s not burnout it’s moral injury and this book highlights all of the reasons why in a very easy to understand way. Ignore the title (which I felt was misleading until I heard the reasoning behind it at the beginning of the book) and know that if you too have been struggling with the direction that health care is going, (or you want to understand why healthcare workers are struggling) this book is for you.
March 27, 2023
I received a copy of this in exchange for my honest review. Thank you NetGalley.
I love medical books. I'm always drawn in to these books that have fun or unique patient stories. I love when doctors can show empathy towards patients and put themselves in their shoes as opposed to being condescending or frequently thinking they know our bodies better than we do.
I know their job isn't easy. The schooling, the grueling hours, etc. It must be hard to find a balance. We all know how broken the healthcare system is, but a lot of us don't realize the toll it takes on the doctors as well. This book describes that all well. Interesting and informative.
I love medical books. I'm always drawn in to these books that have fun or unique patient stories. I love when doctors can show empathy towards patients and put themselves in their shoes as opposed to being condescending or frequently thinking they know our bodies better than we do.
I know their job isn't easy. The schooling, the grueling hours, etc. It must be hard to find a balance. We all know how broken the healthcare system is, but a lot of us don't realize the toll it takes on the doctors as well. This book describes that all well. Interesting and informative.
July 21, 2023
This isn't the most literary work, but it may be the most important book of the past few years. It describes the effect of corporatization in the health care system on doctors, who at first glance you might think would be insulated from it. Unfortunately, they are treated as cogs at a higher level, unable to carry out the oath they take to put patients first. They have become employees of corporate giants and have had the liberty to practice their talents stripped from them. And in small ways they are fighting back, with new movements toward better organization and models of care. The stories are excellent and they actually provide a measure of hope.
April 12, 2023
Dust bowl:
This is a must ready for physicians, aspiring doctors, brave healthcare administrators and ideally, by anyone who has been baffled by the inequities and illogical mess modern healthcare has become. As a physician I could relate to most of the vignettes, and at least one (“Broken”—featuring a colleague) made me horrified about what could have happened to me. The term Moral Injury resonates well and more accurately expresses what many of us have felt, more accurately than burnout or compassion fatigue. Having an accurate term helps promote self-forgiveness, and a pathway beyond the harm.
Why “dust bowl”? Well, I just kept thinking that the current trend of corporate medicine is essentially burning all the good from the practice of medicine, just as aggressive and foolish farming practices destroyed the farmland of the US in the 20’s, resulting in decades of loss and painful recovery.
Is it too late for medicine to recover? I don’t know. I did retire early, though not a day goes by without me replaying concerns and frustrations that lead to this decision.
The insights in this book give me hope, and validation that I wasn’t just imagining a trend where my team—and our dear patients—were merely Revenue Generating Units.
Kudos to the authors and the brave souls who shared their stories
This is a must ready for physicians, aspiring doctors, brave healthcare administrators and ideally, by anyone who has been baffled by the inequities and illogical mess modern healthcare has become. As a physician I could relate to most of the vignettes, and at least one (“Broken”—featuring a colleague) made me horrified about what could have happened to me. The term Moral Injury resonates well and more accurately expresses what many of us have felt, more accurately than burnout or compassion fatigue. Having an accurate term helps promote self-forgiveness, and a pathway beyond the harm.
Why “dust bowl”? Well, I just kept thinking that the current trend of corporate medicine is essentially burning all the good from the practice of medicine, just as aggressive and foolish farming practices destroyed the farmland of the US in the 20’s, resulting in decades of loss and painful recovery.
Is it too late for medicine to recover? I don’t know. I did retire early, though not a day goes by without me replaying concerns and frustrations that lead to this decision.
The insights in this book give me hope, and validation that I wasn’t just imagining a trend where my team—and our dear patients—were merely Revenue Generating Units.
Kudos to the authors and the brave souls who shared their stories
December 3, 2023
This is my working life. All of us in healthcare are asked to do way too much with too little. Overbooked clinics, high acuity, high census, more complex patient loads, prior authorization, EHR/EMR woes, apathetic C-suite, and more- with little to no reprieve. As the author notes, you ask clinicians to do more and they usually will because they care about the patients, but they generally end up eliminating something important to them like bathroom breaks, hydration, lunch, sleep, leaving on time to see family, etc….
So the work is elastic and the resilience of the workers can stretch - but at some point something is bound to snap.
The system is very broken. I am one of the people who think it’s beyond repair, although the author ends on a more hopeful note.
So the work is elastic and the resilience of the workers can stretch - but at some point something is bound to snap.
The system is very broken. I am one of the people who think it’s beyond repair, although the author ends on a more hopeful note.
November 21, 2023
This perfectly articulated so much of what is wrong with our healthcare system. As a MD, I know so many other physicians, and nearly all of us are heartbroken by the way the system often forces us to adjust priorities in patient care- especially in primary care. The scope of the problem is beyond what can be described in a comment here, or even by the entirety of the book. But this book is a start in describing the problems.
July 14, 2023
Vivid descriptions of the challenges of being a physician in a healthcare industry shaped more by accountants than doctors. I would have loved to see more discussion of how we get out of this mess, but there's no question after reading this of the depth and breadth of the mess.
June 28, 2023
VERY DEPRESSING, but essential to read by all healthcare workers. Explains so much--how those EMR's were forced ONTO us instead of adapted to our way of working. And how profit became the driving force in healthcare.
November 27, 2023
Taking off a star d/t how depressing this was :( saddened by how many people itch to make money off others’ health and suffering
July 22, 2023
A jarring read. Written by two physicians who give the inside scoop on the challenges doctors face providing patient care within the United States medical system. After reading the book, it's apparent that our medical system has grown into an enormous (perhaps even uncontrollable) entity that gives little agency to patients and doctors. I now understand why it is so difficult for the average American to navigate the system in pursuit of good health care. The system is a labyrinth of rules, laws, and policies written by insurance companies, federal government agencies, state governments, for-profit and non-profit hospitals, employers’ health plans, and more. And few talk to one another; each operates within its own silo.
Key takeaways:
- Many doctors are prohibited from providing patients with the best possible care due to the rules, pressures, and laws mandated by one or more stakeholders within the system. The authors describe this phenomenon as moral injury.
- Doctors (especially surgeons) are pressured to "produce" financially in hospitals that are driven exclusively by financial metrics. When metrics such as patient satisfaction or positive health outcomes are not included, patient care is compromised.
- The HITECH Act of 2009 added more complexity and cost for medical providers, which has led to increased health care costs for patients. The Act was part of the Recovery Act, which was designed to inject money into various sectors of the economy, in this case, healthcare. One of the main requirements of the Act was electronic patient records. The mandate resulted in significant costs for medical practices (forcing many to go to for-profit companies), less face-time between patient and doctor, and more complexity for all stakeholders. The oversight, still required today, impacts our health care costs. The authors cite a study that determined that $1200 is added to each patient’s bill for a hospital stay to cover costs associated with HITECH (p. 194).
- Another study the author cites outlines that as many as one third of patients would forego lifesaving medical treatment rather than pay for "whatever it takes" and go into bankruptcy or significant debt (p. 182).
If I Betray These Words is not the most uplifting read, but an important book for anyone looking for insight into America’s health care system from doctors’ viewpoints. Some good health care alternatives are also discussed.
Key takeaways:
- Many doctors are prohibited from providing patients with the best possible care due to the rules, pressures, and laws mandated by one or more stakeholders within the system. The authors describe this phenomenon as moral injury.
- Doctors (especially surgeons) are pressured to "produce" financially in hospitals that are driven exclusively by financial metrics. When metrics such as patient satisfaction or positive health outcomes are not included, patient care is compromised.
- The HITECH Act of 2009 added more complexity and cost for medical providers, which has led to increased health care costs for patients. The Act was part of the Recovery Act, which was designed to inject money into various sectors of the economy, in this case, healthcare. One of the main requirements of the Act was electronic patient records. The mandate resulted in significant costs for medical practices (forcing many to go to for-profit companies), less face-time between patient and doctor, and more complexity for all stakeholders. The oversight, still required today, impacts our health care costs. The authors cite a study that determined that $1200 is added to each patient’s bill for a hospital stay to cover costs associated with HITECH (p. 194).
- Another study the author cites outlines that as many as one third of patients would forego lifesaving medical treatment rather than pay for "whatever it takes" and go into bankruptcy or significant debt (p. 182).
If I Betray These Words is not the most uplifting read, but an important book for anyone looking for insight into America’s health care system from doctors’ viewpoints. Some good health care alternatives are also discussed.
April 7, 2023
Such a timely and much needed book on the business of medicine and how administratiors can get in the way of the quality of care provided when profit motive and shareholders' satisfaction are regarded more highly than the patient’s health.
I loved how the issue was presented in the form of a biography, introducing the physicians individually as people who were only trying to do their jobs, getting increasingly frustrated with the status quo and subsequently gaslighted and punished for daring to criticise their employer's ways when they got between them and their oaths to heal. While this book particularly addressed the failings of the US healthcare system, I believe many of those faults apply globally: from overinflated medical bills to dysfunctional health insurance plans, rendering basic care an unaffordable luxury for many. Equally heartbreaking and mind-opening, If I betray These Words is a must read for anyone who is frustrated with the current state of healthcare.
Thank to Netgalley and Steerforth publishing for providing this eARC in exchange for an honest review.
I loved how the issue was presented in the form of a biography, introducing the physicians individually as people who were only trying to do their jobs, getting increasingly frustrated with the status quo and subsequently gaslighted and punished for daring to criticise their employer's ways when they got between them and their oaths to heal. While this book particularly addressed the failings of the US healthcare system, I believe many of those faults apply globally: from overinflated medical bills to dysfunctional health insurance plans, rendering basic care an unaffordable luxury for many. Equally heartbreaking and mind-opening, If I betray These Words is a must read for anyone who is frustrated with the current state of healthcare.
Thank to Netgalley and Steerforth publishing for providing this eARC in exchange for an honest review.
June 23, 2025
This book articulates so well everything I worry about as a healthcare provider in the current healthcare climate. Patients have no idea how much of their treatment is governed by corporate greed and political policy. Powerful. A must read for anyone who is considering a career in healthcare.
May 7, 2023
Excellent. Each chapter tells a different physician perspective on for profit healthcare today. Everyone should read this to understand the healthcare crises. Americans deserve better.
Read
June 24, 20254.5 STARS
How this book ended up on my TBR: My doctor posted on the socials that she was reading this book. As someone who has recently read a bit about medical gaslighting, I was intrigued at seeing another aspect of a deeply flawed healthcare system.
This was an excellent read about the concept of moral injury. Society has been experiencing and talking about burnout for several years, and the timeline even goes back before the COVID pandemic (though the pandemic certainly added fuel to the fire). Drs. Wendy Dean and Simon Talbot sought to be more particular about what physicians were experiencing. It wasn't just that physicians were exhausted or overworked (though both were true). Dean dug further to identify the concept of moral injury, which she defines as the frustration/exhaustion that comes when physicians betray their oaths to their patients because the medical establishment makes them do so. Each chapter of the book is a case study, though several themes emerge. In addition to sharing the history of each person, the authors provide a concise explanation about the institutions where these physicians are practicing, and they include biographical information about CEOs and administrators when they can locate them. A major theme across the stories is the focus on capitalism. Regulations can make it difficult for independent physicians and groups to operate, and the hospitals they join are often owned by companies and investment groups that have no direct connection to healthcare. As a result, administrators are more focused on profit and making investors happy, and that can be at odds with the best ways of running hospitals and treating members of the community. The stories are full of well-meaning physicians who take up their careers to support their communities, only to be met with impossible quotas, limited appointments, and drastically scarce resources.
The themes and stories were often consistent, but each story did have some unique factors. It's a great collection of personal accounts and research that help us better understand why healthcare is so complicated. I follow a few physicians on Instagram, and one of them is Dr. Elisabeth Potter (@drelisabethpotter). I thought about her a lot as I was reading this book; she often records videos of her talking to insurance companies to authorize the procedures her patients are asking for, and the back-and-forth is just so frustrating. She talks about how she has to take time out of her day, her busy day of treating patients, to speak with doctors who work for insurance companies who may or may not know about her specialty, and they often tell her "well, you've already been denied, so you'll have to appeal."
At the end of the book, the authors do have some general recommendations for how to make the system better, though they are realistic about the timing and form of those improvements. They recommend having both administrators and doctors in decision-making teams. They recommend all levels of government remove restrictions that only seem to impact independent physician groups and physicians. And they speak a little about cleaning up questionable insurance practices.
It seems like the book is very validating for physicians, but I think this is an important read for anyone who wants to better understand why our healthcare system isn't working and how we can possibly fix it.
--
PS. My days on GoodReads are likely numbered. If you all ever go to The StoryGraph, let's be friends there! Here's my profile.
How this book ended up on my TBR: My doctor posted on the socials that she was reading this book. As someone who has recently read a bit about medical gaslighting, I was intrigued at seeing another aspect of a deeply flawed healthcare system.
This was an excellent read about the concept of moral injury. Society has been experiencing and talking about burnout for several years, and the timeline even goes back before the COVID pandemic (though the pandemic certainly added fuel to the fire). Drs. Wendy Dean and Simon Talbot sought to be more particular about what physicians were experiencing. It wasn't just that physicians were exhausted or overworked (though both were true). Dean dug further to identify the concept of moral injury, which she defines as the frustration/exhaustion that comes when physicians betray their oaths to their patients because the medical establishment makes them do so. Each chapter of the book is a case study, though several themes emerge. In addition to sharing the history of each person, the authors provide a concise explanation about the institutions where these physicians are practicing, and they include biographical information about CEOs and administrators when they can locate them. A major theme across the stories is the focus on capitalism. Regulations can make it difficult for independent physicians and groups to operate, and the hospitals they join are often owned by companies and investment groups that have no direct connection to healthcare. As a result, administrators are more focused on profit and making investors happy, and that can be at odds with the best ways of running hospitals and treating members of the community. The stories are full of well-meaning physicians who take up their careers to support their communities, only to be met with impossible quotas, limited appointments, and drastically scarce resources.
The themes and stories were often consistent, but each story did have some unique factors. It's a great collection of personal accounts and research that help us better understand why healthcare is so complicated. I follow a few physicians on Instagram, and one of them is Dr. Elisabeth Potter (@drelisabethpotter). I thought about her a lot as I was reading this book; she often records videos of her talking to insurance companies to authorize the procedures her patients are asking for, and the back-and-forth is just so frustrating. She talks about how she has to take time out of her day, her busy day of treating patients, to speak with doctors who work for insurance companies who may or may not know about her specialty, and they often tell her "well, you've already been denied, so you'll have to appeal."
At the end of the book, the authors do have some general recommendations for how to make the system better, though they are realistic about the timing and form of those improvements. They recommend having both administrators and doctors in decision-making teams. They recommend all levels of government remove restrictions that only seem to impact independent physician groups and physicians. And they speak a little about cleaning up questionable insurance practices.
It seems like the book is very validating for physicians, but I think this is an important read for anyone who wants to better understand why our healthcare system isn't working and how we can possibly fix it.
--
PS. My days on GoodReads are likely numbered. If you all ever go to The StoryGraph, let's be friends there! Here's my profile.
February 26, 2024
Responsibility and accountability without authority is well known in the business world a recipe for dysfunction and deep dissatisfaction in the workplace. But in healthcare, it has become accepted practice, and the consequences for doctors... to try and fail to change their health systems, is moral injury.
~p194-5
3.5 STARS
Wendy Dean is a former physician who aims to outline “moral injury” as a new way to consider “burnout” among modern physicians and surgeons. Burnout can be a real phenomenon, but she argues it is overused as a term and is not the primary reason for anomie and malaise and unhappiness among medical professionals. Moral injury is the concept that fits the phenomenon better. Her original essay with a surgeon colleague was published in 2018. One definition of moral injury is “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” A less literary definition, and one that resonates with me: “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
While the book promises insights, its structure prevents it from lacking full force, in my view. There are 12 main chapters, each of which starts with a clinical vignette centered around a person (mostly ER doctors or surgeons) and some intractable problem. Most of these are staffing issues (under-resourced or understaffed ERs, corporate takeover of health systems, shuttering of rural or suburban hospitals, unworkable electronic medical records).
Some of the tales are more interesting than others, but there are two features that detract from effectiveness. First, there is a focus on the persons themselves, and getting the biography of 15-20 physicians (where they grew up, where they trained) is cognitively overloading and almost always irrelevant to the point Dean and Talbot are trying to make. Further, there is the occasional use of narrative structure (i.e. describing the sighs or the exact quotations of a fraught encounter between medical providers, and these literary flourishes generally ring false).
Comments about current challenges are on-point, in my view:
EMRs have driven clinicians apart from their patients during the day, and their families at night, without substantive improvements to the care they can deliver, or the ease with which they can do it.
~p77
Overall, the bones of the work are good. And this underlying structure, plus my own interest (I am a salaried surgeon at a “nonprofit” children’s hospital) have served as an incitement to further reading. For example, there is a terrifically interesting example of an ER physician who sued his hospital system for wrongful termination, when they punished him for being a whistleblower on their deliberate understaffing of an ER to maximize profit (in this case, one ER doc staffed two separate ER sections, adult and pediatric, and was also the hospital’s Code Blue provider – potentially meaning they had to cover 3 emergent situations at once). This doc’s example, and how he fought back (and won) is quite interesting.
Worthy of a quick read, but a shorter and more focused work would have been even more effective.
~p194-5
3.5 STARS
Wendy Dean is a former physician who aims to outline “moral injury” as a new way to consider “burnout” among modern physicians and surgeons. Burnout can be a real phenomenon, but she argues it is overused as a term and is not the primary reason for anomie and malaise and unhappiness among medical professionals. Moral injury is the concept that fits the phenomenon better. Her original essay with a surgeon colleague was published in 2018. One definition of moral injury is “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.” A less literary definition, and one that resonates with me: “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
While the book promises insights, its structure prevents it from lacking full force, in my view. There are 12 main chapters, each of which starts with a clinical vignette centered around a person (mostly ER doctors or surgeons) and some intractable problem. Most of these are staffing issues (under-resourced or understaffed ERs, corporate takeover of health systems, shuttering of rural or suburban hospitals, unworkable electronic medical records).
Some of the tales are more interesting than others, but there are two features that detract from effectiveness. First, there is a focus on the persons themselves, and getting the biography of 15-20 physicians (where they grew up, where they trained) is cognitively overloading and almost always irrelevant to the point Dean and Talbot are trying to make. Further, there is the occasional use of narrative structure (i.e. describing the sighs or the exact quotations of a fraught encounter between medical providers, and these literary flourishes generally ring false).
Comments about current challenges are on-point, in my view:
EMRs have driven clinicians apart from their patients during the day, and their families at night, without substantive improvements to the care they can deliver, or the ease with which they can do it.
~p77
Overall, the bones of the work are good. And this underlying structure, plus my own interest (I am a salaried surgeon at a “nonprofit” children’s hospital) have served as an incitement to further reading. For example, there is a terrifically interesting example of an ER physician who sued his hospital system for wrongful termination, when they punished him for being a whistleblower on their deliberate understaffing of an ER to maximize profit (in this case, one ER doc staffed two separate ER sections, adult and pediatric, and was also the hospital’s Code Blue provider – potentially meaning they had to cover 3 emergent situations at once). This doc’s example, and how he fought back (and won) is quite interesting.
Worthy of a quick read, but a shorter and more focused work would have been even more effective.
March 18, 2024
3.75
I thought overall this presented a thorough, investigative look at different practices that have been at the forefront of physician moral injury over the past years. Even though I am just starting my healthcare career, I have already heard many conversations either directly or indirectly alluding to the ideas of burnout vs moral injury, and having a full book dedicated to these conversations feels important in changing the status quo. I appreciate her intertwining of personal reflections and profiles with the more statistic-drive expository writing, and thought was generally effective in furthering the idea that healthcare cannot be squeezed into a business model.
I wish that she would have drawn in more comparisons to other countries both in their provider satisfaction and patient outcomes, as the US is not the only place facing an aging population, or the COVID pandemic. I think this would have helped push the idea that the US created policies to get us in the current state, and we do not have to reinvent the wheel necessarily to make change, but look at what is already working for other places. Another issue I had was how the model for current physicians to follow - the people who had been able to find their place or make change - was also depictions of people who sacrificed so much of their life outside of medicine to get there. In her advice in the conclusion, Wendy herself tells physicians to study policy, regulatory, legislative, and financial constraints in their organization. This feels just so out of reach for people who are struggling to find the time to just work and exist, and it feels like you have to be a hero to just survive. I do not think it is bad to suggest this, but I think there needs to be some acknowledgment of just how much of a tole this can take, and how unfeasible it is for many, and just some realism of what it takes from a person.
I thought overall this presented a thorough, investigative look at different practices that have been at the forefront of physician moral injury over the past years. Even though I am just starting my healthcare career, I have already heard many conversations either directly or indirectly alluding to the ideas of burnout vs moral injury, and having a full book dedicated to these conversations feels important in changing the status quo. I appreciate her intertwining of personal reflections and profiles with the more statistic-drive expository writing, and thought was generally effective in furthering the idea that healthcare cannot be squeezed into a business model.
I wish that she would have drawn in more comparisons to other countries both in their provider satisfaction and patient outcomes, as the US is not the only place facing an aging population, or the COVID pandemic. I think this would have helped push the idea that the US created policies to get us in the current state, and we do not have to reinvent the wheel necessarily to make change, but look at what is already working for other places. Another issue I had was how the model for current physicians to follow - the people who had been able to find their place or make change - was also depictions of people who sacrificed so much of their life outside of medicine to get there. In her advice in the conclusion, Wendy herself tells physicians to study policy, regulatory, legislative, and financial constraints in their organization. This feels just so out of reach for people who are struggling to find the time to just work and exist, and it feels like you have to be a hero to just survive. I do not think it is bad to suggest this, but I think there needs to be some acknowledgment of just how much of a tole this can take, and how unfeasible it is for many, and just some realism of what it takes from a person.
May 24, 2023
This is an important work for all professionals to read. We read a lot about mental health issues in the professions: burnout, anxiety, alcoholism, divorce, drug addiction, even suicides (“physicians die by suicide at nearly twice the rate of the general population.”). How much of it is actual “burnout” and how much of it is what the authors label “moral injury”? This idea, I believe, explains more—not all—of what we would normally label burnout. They being by quoting a 2010 translation of the Hippocratic Oath, which was also the source for the title of the book:
"I pray that the attention I give to those who put themselves in my hands be rewarded with happiness. …If I ever break this oath, let my gods take away my knowledge of this art and my own health. Here speaks a citizen, a servant of people. May I be destroyed if I betray these words.
This is not “simply about how we will do a job, it is also about who we will be when we don the mantel of ‘physician.’"
"In standing up to the moral injury and fighting for our oaths, we are fighting for our patients as if our lives depend on it. Because, figuratively, and too often literally, they do.”
The book is a series of stories of CEOs and doctors whose lives have been changed by consolidations in the healthcare industry affecting hospitals and physician practices. How healthcare has become a business—whether for-profit or non-profit [“No margin, no mission” is the new mantra]—and how this puts stress on clinicians who cannot do what is best for the patient, hence not living up to their oath, resulting in moral injury. In 1988, only 28% of doctors worked in large organizations; by 2021 it is 70%The pressure of having to see more patients in less time, bill for more services, have fewer support staff, and use technology that interfered with the care of patient—the fee-for-service treadmill of healthcare—all inflict moral injury. But this isn’t about the doctor’s mental health, it’s a faulty business model. If 50% of your lightbulbs burned out when you screwed them in, you wouldn’t blame the individual bulbs but rather than the faulty electrical system. The business model is the electrical system, and as the authors say, “it is caught in a conflict between the profit motive of their employers and their oaths to heal.”
Moral injury was first use to describe the traumatic experience of Vietnam veterans: “perpetrating, bearing witness to, or failing to prevent acts that transgress deeply held moral beliefs and expectations.” Today, physicians “are working harder and harder to meet ever-increasing, always changing performance targets… But their bigger concern is that they are breaking a promise they made years ago, when they entered the profession of medicine — that they would do no harm and always put patients first.” They describe one hospital’s management expectation of physicians:
"Management wanted physicians doing billable tasks for 95 percent of the hours specified in their contracts. that expectation belies a fundamental misunderstanding of how physicians work. Patient care requires communication, care coordination, records reviews, and troubleshooting, which for most physicians amounts to roughly two hours of additional work for every hour of billed clinic time. Administrators knew doctors would find time for non-billable tasks — even if it meant working one hundred hours a week — because, as internal medicine specialist. For most doctors and nurses, it is unthinkable to walk away without completing your work because dropping the ball could endanger your patients.”
And even though government payment models have shifted from fee-for-service to so-called “value-based care,” the overriding incentive is still to do things to patients rather than for them. Obamacare mandated the adoption of Electronic Health Records or suffer lower reimbursement rates. In a 2017 interviewed he admitted “it’s proven to be harder than we expected.” That’s what happens when you try to centralize plan the economy. Direct primary care doctors, since they don’t take insurance, don’t use electronic health records, or if they do, it’s because they are effective, not mandated. If it’s a good idea, you shouldn’t have to mandate it.
The other side of this story is that if doctors push back on their employers they could be deemed mentally unfit, or suffering burnout, and if they refuse treatment it could jeopardize their medical license. The stories told about this to real doctors are chilling.
The authors do profile a direct primary care physician, but they assert that DPC is no panacea, since if every primary care doctor switched to that model patients couldn’t find a doctor. But compared to what? Single payer health care? And how about the fact that the DPC model would encourage doctors to enter general care—thus alleviating the shortage—since they would no longer suffer moral injury?
In other words, the authors provide an excellent diagnosis, but their prescriptions would be worse than the disease. They also discuss financial toxicity, whereby doctors carrying out tests and procedures, some are covered by insurance, some not, create anxiety for the patients. This is the problem with third-party payments, employer-provided healthcare, and how healthcare is paid for in general, but the authors don’t discuss this issue like economists do. Nor would I expect them to. But you cannot blame this on the profit motive, capitalism, free markets, or a caricature of Milton Friedman’s 1970 essay, which wasn’t about shareholder value but rather maximizing profit within ethical boundaries.
Some of their recommendations: strict limits on consolidation and vertical integration by healthcare corporations; harmonize federal regulations on documentation; insurance reform. These proposed reforms demonstrate how out-of-control and overbearing the government is in this sector.
Healthcare in this country is nowhere near being a free market. DPCs provide a random controlled trial of what healthcare could be if a free market was allowed to rein, restoring consumer sovereignty and the sacred doctor-patient relationship. It also provides affordable care, price transparency, and competition. This would go a long in reducing moral injury.
Disagreements aside, this is an excellent book and I applaud the authors for deepening our understanding of what is happening, not only to doctors, but to professionals in general who operate under a flawed and suboptimal business model.
"I pray that the attention I give to those who put themselves in my hands be rewarded with happiness. …If I ever break this oath, let my gods take away my knowledge of this art and my own health. Here speaks a citizen, a servant of people. May I be destroyed if I betray these words.
This is not “simply about how we will do a job, it is also about who we will be when we don the mantel of ‘physician.’"
"In standing up to the moral injury and fighting for our oaths, we are fighting for our patients as if our lives depend on it. Because, figuratively, and too often literally, they do.”
The book is a series of stories of CEOs and doctors whose lives have been changed by consolidations in the healthcare industry affecting hospitals and physician practices. How healthcare has become a business—whether for-profit or non-profit [“No margin, no mission” is the new mantra]—and how this puts stress on clinicians who cannot do what is best for the patient, hence not living up to their oath, resulting in moral injury. In 1988, only 28% of doctors worked in large organizations; by 2021 it is 70%The pressure of having to see more patients in less time, bill for more services, have fewer support staff, and use technology that interfered with the care of patient—the fee-for-service treadmill of healthcare—all inflict moral injury. But this isn’t about the doctor’s mental health, it’s a faulty business model. If 50% of your lightbulbs burned out when you screwed them in, you wouldn’t blame the individual bulbs but rather than the faulty electrical system. The business model is the electrical system, and as the authors say, “it is caught in a conflict between the profit motive of their employers and their oaths to heal.”
Moral injury was first use to describe the traumatic experience of Vietnam veterans: “perpetrating, bearing witness to, or failing to prevent acts that transgress deeply held moral beliefs and expectations.” Today, physicians “are working harder and harder to meet ever-increasing, always changing performance targets… But their bigger concern is that they are breaking a promise they made years ago, when they entered the profession of medicine — that they would do no harm and always put patients first.” They describe one hospital’s management expectation of physicians:
"Management wanted physicians doing billable tasks for 95 percent of the hours specified in their contracts. that expectation belies a fundamental misunderstanding of how physicians work. Patient care requires communication, care coordination, records reviews, and troubleshooting, which for most physicians amounts to roughly two hours of additional work for every hour of billed clinic time. Administrators knew doctors would find time for non-billable tasks — even if it meant working one hundred hours a week — because, as internal medicine specialist. For most doctors and nurses, it is unthinkable to walk away without completing your work because dropping the ball could endanger your patients.”
And even though government payment models have shifted from fee-for-service to so-called “value-based care,” the overriding incentive is still to do things to patients rather than for them. Obamacare mandated the adoption of Electronic Health Records or suffer lower reimbursement rates. In a 2017 interviewed he admitted “it’s proven to be harder than we expected.” That’s what happens when you try to centralize plan the economy. Direct primary care doctors, since they don’t take insurance, don’t use electronic health records, or if they do, it’s because they are effective, not mandated. If it’s a good idea, you shouldn’t have to mandate it.
The other side of this story is that if doctors push back on their employers they could be deemed mentally unfit, or suffering burnout, and if they refuse treatment it could jeopardize their medical license. The stories told about this to real doctors are chilling.
The authors do profile a direct primary care physician, but they assert that DPC is no panacea, since if every primary care doctor switched to that model patients couldn’t find a doctor. But compared to what? Single payer health care? And how about the fact that the DPC model would encourage doctors to enter general care—thus alleviating the shortage—since they would no longer suffer moral injury?
In other words, the authors provide an excellent diagnosis, but their prescriptions would be worse than the disease. They also discuss financial toxicity, whereby doctors carrying out tests and procedures, some are covered by insurance, some not, create anxiety for the patients. This is the problem with third-party payments, employer-provided healthcare, and how healthcare is paid for in general, but the authors don’t discuss this issue like economists do. Nor would I expect them to. But you cannot blame this on the profit motive, capitalism, free markets, or a caricature of Milton Friedman’s 1970 essay, which wasn’t about shareholder value but rather maximizing profit within ethical boundaries.
Some of their recommendations: strict limits on consolidation and vertical integration by healthcare corporations; harmonize federal regulations on documentation; insurance reform. These proposed reforms demonstrate how out-of-control and overbearing the government is in this sector.
Healthcare in this country is nowhere near being a free market. DPCs provide a random controlled trial of what healthcare could be if a free market was allowed to rein, restoring consumer sovereignty and the sacred doctor-patient relationship. It also provides affordable care, price transparency, and competition. This would go a long in reducing moral injury.
Disagreements aside, this is an excellent book and I applaud the authors for deepening our understanding of what is happening, not only to doctors, but to professionals in general who operate under a flawed and suboptimal business model.
August 17, 2023
After spending the past 3 1/2 years volunteering for the Physician Support Line (created at the beginning of the pandemic), I found this book to be an essential read for anyone concerned about the current state of medicine in the US. Dr. Dean interviewed amazingly impressive physicians in her pursuit of understanding and articulating the moral injury to devoted docs by systemic and financially driven pressures (that predated the pandemic), the results of which should trouble the rest of us as profit is put before patients and docs are seen as "profit generating units" in both for-profit and many supposedly non-profit systems. In the midst of reading this book I received a call from a young surgeon whose story could've easily been included in Dean's book. These stories are real, and all too frequent. Fortunately, Dean also provides answers for righting a system that has been heading in the wrong direction for far too long, but takes the courage to follow an ethical and moral compass despite the well funded roadblocks-- meaning many docs will have to opt out of the usual available positions, others will do what they can within the few systems that listen to the practicing physicians to insure patients' needs are put first, and many fights will be fought in the courts. She outlines why the current trends are dangerous for docs and patients alike, and drastic change is necessary.
February 2, 2023
I had been hearing grumblings from some of my doctors for years about there is more focus on record keeping then on patient care.
It wasn't until one of my primary care doctors went into a Direct Care Model on her own, that I really fully understood just how broken doctors were.
The authors do a wonderful job of describing and relating what a "moral injury" is and how it affects doctors.
Everyone in America knows the healthcare system is broken, but this is the first book that explored how DOCTORS are handling the cracks, the demand to keep making profits, and more importantly what can be done to remedy the situation.
I want to thank the authors for pointing out and writing about moral injury and the increasing challenges that doctors are under to keep making money for their 'healthcare' systems.
Thank you to Netgalley and to the publisher for this ARC in exchange for this honest review.
It wasn't until one of my primary care doctors went into a Direct Care Model on her own, that I really fully understood just how broken doctors were.
The authors do a wonderful job of describing and relating what a "moral injury" is and how it affects doctors.
Everyone in America knows the healthcare system is broken, but this is the first book that explored how DOCTORS are handling the cracks, the demand to keep making profits, and more importantly what can be done to remedy the situation.
I want to thank the authors for pointing out and writing about moral injury and the increasing challenges that doctors are under to keep making money for their 'healthcare' systems.
Thank you to Netgalley and to the publisher for this ARC in exchange for this honest review.
May 22, 2024
If you have ever suffered severe mistreatment, been refused treatment or been left permanently injured by the negligence of a medical practitioner, take care of yourself when reading this. I found it extremely triggering and just.. it was tough.
I haven't finished reading it but my review is ready.
I feel sick. I am sickened and just plain angry.
Everything you've ever feared about the medical industry is true, believe me, I've seent it, and suffered it.
💲They want your money, and your health💲
This book is the testimonies of the people who appear on the other side, the people who have sworn to do no harm, the people there to help you.
They are the whistleblowers, and they are courageous as fuck.
This world is a hard one, it really is, but...
Superheroes always win in the end.
"The only thing necessary for the triumph of evil is for good men to do nothing.”
I haven't finished reading it but my review is ready.
I feel sick. I am sickened and just plain angry.
Everything you've ever feared about the medical industry is true, believe me, I've seent it, and suffered it.
💲They want your money, and your health💲
This book is the testimonies of the people who appear on the other side, the people who have sworn to do no harm, the people there to help you.
They are the whistleblowers, and they are courageous as fuck.
This world is a hard one, it really is, but...
Superheroes always win in the end.
"The only thing necessary for the triumph of evil is for good men to do nothing.”
October 27, 2024
If you’re a healthcare worker or someone who cares about how the healthcare system works, (to paraphrase the author) “You can tell yourself that working in healthcare in the US requires compromise. But if you succumb to moral injury, you know you are consenting to your own destruction. So choose to fight - for your integrity as a healthcare worker, for your patients, for the profession of medicine.” This book feels akin to the tradition of Atul Gawande, while not quite hitting his mark. It will give you understanding, validation, “visceral” discomfort, and ultimately ideas & motivation to be a team member who advocates for changes that “take medicine back” from business models that don’t put patients or clinicians first. For me personally, the chapter on EMR has opened my eyes to how we got here & why I feel angry every time documentation keeps me from spending more time doing what is most important - taking care of patients.
October 25, 2024
If I Betray These words gives a real life account of some doctors and their struggle to continue to provide care amidst the restrictions of big box health care conglomerates and insurance companies. The book was pretty informative, but there were two things that made me feel some type of way while reading. The first was saying that LPN's are not nurses, when they sit for a licensing board just like RN's, (and this is coming from someone who has been an RN for years. The second, It read like only one black doctor was included. There were plenty of stories from non black presenting doctors in regards to the opioid epidemic, but only one for the needs of some black patient. Not one word regarding the high maternal death rate that happens to black women still today. Other than those major issues, it was an informative and solid read.
November 6, 2025
“Managing at a distance from the community means those who suffer are no longer neighbors, friends, and acquaintances; their pain becomes faceless and their needs hypothetical.”
This is what happens when corporate interests usurp family practice, and physicians and care providers are left behind. Dr. Dean provides fellow doctors’ real accounts from across the country, including my home, Carlisle, which was a bonus. Within the stories, she cites research and academic journals, adding context to how these reflect greater national trends. And it’s bleak.
I thought maybe the order of the stories could have been stronger, with perhaps a little more emphasis on flow. Other than that, I have nothing but praise for this title. It’ll stick with me next time I’m rushed through a doctor appointment. There are quotas to hit!
This is what happens when corporate interests usurp family practice, and physicians and care providers are left behind. Dr. Dean provides fellow doctors’ real accounts from across the country, including my home, Carlisle, which was a bonus. Within the stories, she cites research and academic journals, adding context to how these reflect greater national trends. And it’s bleak.
I thought maybe the order of the stories could have been stronger, with perhaps a little more emphasis on flow. Other than that, I have nothing but praise for this title. It’ll stick with me next time I’m rushed through a doctor appointment. There are quotas to hit!
November 12, 2025
Very scholarly, at times textbook-esque read but still very human. Parts of the book dragged a bit, but felt that any slow points were worth the wisdom contained in its pages. I was especially intrigued by the author's discussion of Jennifer Freyd's research on “betrayal blindness,” a term to describe how people avoid consciously acknowledging harmful interpersonal or organizational dynamics to maintain their view of themselves as good people doing good work, rather than agents participating in and protecting exploitative systems. I think this really resonated with me because I feel the pull of this moral current in my role as a medical student. It's easier to “put on your blinders” when you witness unethical behavior in medicine than to assume the personal and professional risks of moral courage.
May 27, 2024
Too many thoughts and not enough time. This book confirmed for me something I’ve suspected for a long time: I don’t think I can be satisfied working as a physician in the current healthcare system. The corruption, cost, moral injury, and lack of autonomy isn’t something I can watch every day and go home feeling happy and fulfilled. This book highlights stronger, brighter, more motivated people than I who had to walk away for their own sanity. I highly doubt I can (or want to) succeed where they failed. Not that this book is despairing or hopeless, but rather an honest appraisal of the US healthcare system. Eye opening and highly recommended for those inside or outside the system who want to look behind the curtain.
September 2, 2023
Moral injury must be differentiated from burnout of physicians; burnout is the real result of overwork, but moral injury occurs when the demands of corporate healthcare are at odds with the fundamental values of medical care. Doctors accept the sacrifices of a very demanding career because of their deeply felt drive to take care of patients and develop personal standards of care. When business needs compel behaviors that are at odds with those standards, moral injury occurs and that is driving people out of health care. The author illustrates this clash of values in several stories. Clinicians will recognize many of these stories, but patients should read this and learn.
November 14, 2023
I am an OBGYN and was a chief resident at a busy academic medical center during the peak of the pandemic. Every ounce of my being felt this book. It gives context to the war between Hippocrates and capitalism. Captivating. Cathartic. Absolutely enraging. Dr. Dean captures perfectly the state of the healthcare system in this country (USA) where care is overly expensive and yet subpar. She illustrates how the healthcare system serves its shareholders at the expense of the most important members, our patients and their clinicians. A call to action, to organized medicine, to doctors and communities taking back the doctor patient relationship. Get pissed. Let’s fix this.
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