The Moral Distress Syndrome Affecting Physicians

The rise of suicide and burnout among physicians has brought a new disease to the healthcare provider, which we previously thought only affected the soldier: moral distress syndrome, second only to moral injury. In this book we introduce the concept of moral distress syndrome, which includes any or all of the following: depression, PTSD, risk of suicide, divorce, emotional detachment, and the inability to build healthy relationships and empathy. While veterans can report to veteran hospitals for treatment, the physician cannot find treatment or support without fear of losing their license, their hospital privileges, and their job. Therefore, they are stuck dealing with the issue themselves, along with their family or their circle of friends. To raise decisive awareness of the problems related to moral distress, we wrote this book. This book is designed around physicians talking to other physicians about their moral distresses in a safe space. It brings all the aspects of the moral distress syndrome in a format familiar to the physician: grand rounds with a magistral lecture, where the audience asks the question and directly participates on the subject. The reader will feel like part of the audience and may want to ask their own questions as the book progresses. The format of the book is divided into three parts. In the first part, the research, data, and a crude number of problems are given: moral distress syndrome, PTSD, burnout, suicide, divorce rates, emotional detachment, legal distress syndrome, physicians leaving medicine, and the feeling of being a hamster in a wheel. In the second part, we embellish on real life experiences of physicians to highlight the pain and depth of the moral distress they feel. We share stories around the character-their family, love life, divorce, etc.-to show the individual person behind the doctor. In the third part, we focus on society and physician suffering and the birth of moral distress. This part focuses on the physician's empathy as a way to point out his problems, weaknesses, and issues, and find possible solutions for him and other physicians facing the same issues. At the end of the third part, we discuss how it is the responsibility of physicians, patients, and society as a whole to heal in the face of moral injury, as recommended by the American Medical Association. We finish with the search for good friends and safe spaces, the cornerstones for the healing process. Structure of the Chapters. To make it easier to follow the material, at the beginning of each chapter we outline the points discussed, as a speaker outlines the material, summarizing it in the first slide of each topic. We hope that this way the readers can focus on the issues quickly throughout the book. This book is formatted as a business novel and therefore the characters and situations are drawn from liberally. As well as reading like a novel, the reader can read each chapter separately and still understand the points.

Eldo E. Frezza is a Fellow of the American College of Surgeons (FACS), American Medical Association, American Medical Physician Leadership. He is now Chief of Surgery at Nashville General Hospital and Professor at Meharry Medical school.

PART I: THE ISSUES FUELING THE MORAL DISTRESS SYNDROME 1. The Grand Round lecture 2. Moral Distress Syndrome 3. Litigation syndrome 4. Burn out 5. Suicide from Medical Student to residents to clinicians 6. Why Physicians suffer more suicides? 7. Malpractice: can create everlasting injury 8. Why is Medicine burning out physicians? 9. Broken system and corporate culture 10. Physician Leaving Medicine 11. Impossible Victory: working as a chain worker 12. Emotional trauma: brain zapping and concussion 13. Divorce among physicians 14. Medical Malpractice Insurance crises 15. Opioid crisis and relief PART II: THE DOCTOR, THE MAN 16.Training hurdles 17. Double Residencies 18. How medicine can ruin a marriage 19. The Legal Issues and hollow victory 20. Inability to return to work: the apex of Moral distress PART III: THE SOCIETY AND THE SUFFERING PHYSICIANS 21. Society responsibilities 22. Emotional detachment and Patients responsibilities 23. Do patients want to participate in their care? 24. It is challenging to be a physician 25. The loneliness of a Physician in moral distress 26. Divorce because of moral distress 27. The stress of the lawsuit breaks family 28. The birth of moral distress: the syndrome 29. Are physicians discriminated? 30. The American Medical Association (AMA) Directions 31. Safe space and final Introspections

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