THIS TIME ON CODE WACK!
What happens when doctors feel forced to act against their own moral compass? When financial barriers—not clinical judgment—determine the care a patient receives?
We’re talking about moral injury in medicine—how it’s affecting physicians, harming patients, and why it’s getting worse under our profit-driven healthcare system.
Joining us is Dr. Diljeet Singh, an integrative gynecologic oncologist and president of Physicians for a National Health Program. She shares powerful stories from her own practice—and from the front lines of American healthcare—that reveal a deeper crisis than just burnout. This is the first episode in a two-part series.
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SHOW NOTES
WE DISCUSS
What is ‘moral injury’?
“… moral injury is a term that comes from the military and in the context of the military, it speaks to the injury that soldiers and other members of the military when they feel like what they’re doing goes against their moral center and is often a big component of it is betrayal.
“And that is that they feel betrayed by their leadership, by the people in power and in the military, which is so obviously hierarchical and where so much depends on that, just following orders. It’s a very different culture.– Diljeet Singh, MD
What is ‘moral injury’ in the context of health care and the physician experience?
“… nurses might feel more of a sense of hierarchy and some of the moral injury identified in their world was also about physicians or managerial sort of positions pushing them to do things that they didn’t agree with.
“But … in the physician literature, we had been talking about … ‘burnout.’ And burnout is something that’s real, right? Burnout is this idea that people come to a place where they are fatigued and they don’t see patients as people and they don’t take joy in their work.
“… [there is] this underlying implication that it’s the individual who is not quite doing the right self-care, or not quite seeing the world correctly, and who just needs to meditate more or take more vacations or spend more time with their family and that will cure their burnout. And it fails to recognize that there might be system-wide issues, that any kind of individual change could not make any difference. – Diljeet Singh, MD
So your organization, Physicians for a National Health Program, is studying the impact of ‘moral injury’ and ‘financialization’ on American doctors. Tell us about that.
“… we got funding [from the Robert Wood Johnson Foundation] and started … doing focus groups and surveys and now interviews of physicians …
“… if everybody out there understands that many doctors feel like they are doing the wrong thing every day, that it’s something against their moral code, that would help everybody understand why we have to change it.
“Physicians shouldn’t feel like they are at war and patients shouldn’t have to worry about what is guiding the recommendations their physician is making. Is it the stuff that their insurance company will cover or is it what’s actually right for them?
“… Is that physician worried they ordered too many PET scans this month and they’re not allowed to get one again? I do really struggle with why this doesn’t seem so clear and obvious.
“And why we could believe, even for a moment, that capitalism is the way to provide health care?” – Diljeet Singh, MD
Helpful Links
Prescription for Healthcare—moral injury and burnout, Physicians for a National Health Program
Understanding Moral Injury in Health Care, Physicians for a National Health Program
Physicians aren’t ‘burning out.’ They’re suffering from moral injury, STAT
The Association of Moral Injury and Healthcare Clinicians’ Wellbeing: A Systematic Review, PubMed
Moral Injury of Health Care, Wendy Dean MD and Simon Talbot MD
43cc Podcast, The Truth About Health Care (with a shot to dull the pain)
Episode Transcript
Read the full episode transcript.
Biography: Diljeet Singh, MD
My name is Diljeet K. Singh and I am a women’s health advocate using she/her pronouns. I am an integrative gynecologic oncologist and I’ve been in practice since 1999. I work with women who have ovarian, endometrial, cervical, vulvar, or vaginal cancer or have symptoms or a test that suggests there’s a possibility of one of these cancers or have a genetic risk for getting one of these cancers.
I love my calling which is fulfilling and inspiring; however, the work has shown me the catastrophic shortcomings of our healthcare system and the pernicious effects of racism, classism, sexism and misogyny in medicine and their harmful impact on the health of our society as individuals and collectively.
The innumerable stories of the people I have cared for compel me to give them voice and to use their experiences to advocate for equity and access to opportunities for best health for all.
I currently work with Virginia Oncology Associates in Norfolk, VA. I received my medical degree from Northwestern University and master’s degree from the Harvard School of Public Health. I completed an obstetrics and gynecology residency at the Johns Hopkins Hospital and a gynecologic oncology fellowship at the MD Anderson Cancer Center.
I completed a doctoral degree in public health on cost analysis at the University of Texas School of Public Health and an associate fellowship in integrative medicine at the University of Arizona. I am the president of Physicians for a National Health Program working to achieve universal health care.
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