THIS TIME ON CODE WACK!
Most of us know that our profit-driven healthcare system results in moral injury. How is moral harming physicians? And how is it harming patients? Dr. Diljeet Singh is an integrative gynecologic oncologist and the president of Physicians for a National Health Program. She’s leading a powerful new project with the Robert Wood Johnson Foundation to find out.
By gathering stories from doctors and patients across the country, her team is uncovering how corporate control and financial pressures are fueling moral injury in medicine—and what it will take to make things right. From physicians losing autonomy to entire communities losing access to care, the stakes are real—and deeply personal. This is the second episode in a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
What’s something unexpected you’ve realized from this project?
“I will be honest with you, Brenda, when I started the project, I thought this would be something really important and interesting for physicians, you know, us drawing these connections between loss of autonomy and what that means when you have somebody in front of you who trusts you and who you took an oath to take care of.
“But the conversation you initiated of ‘how does this impact health care?’ and ‘how does this ripple out to patients?’ … [even I] didn’t make those connections.
“And so fortunately the foundation, the Robert Wood Johnson Foundation, has been interested in specifically what we call narrative work or, or storytelling. And again, [it’s a] rich important way to think through these issues that are all about quality and our spiritual beliefs … our moral core.” – Diljeet Singh, MD
How is the project being conducted?
“… there’s a part of it that’s focused on physicians, and we did a series of … focus groups working through, and God, it became so clear that this was just something that almost nobody doesn’t feel some aspect of this. And then we’ve started a survey, and that survey work will be interesting to continue where we specifically started asking questions that haven’t been asked exactly this way before.
“And now we’re doing in-depth interviews, 60 to 90 minute interviews with physicians who expressed an interest in talking. And we’re about one third way through that. And again, the stories and the feelings and the things that come up, it really, really is clear like we are in crisis, the healthcare workforce, nurses, doctors and everybody around us are in crisis.
“And then the third part of our project is patient focus groups. And we’re going to look specifically at areas where there have been dramatic changes in ability to access care related to financialization. For example, in Oregon where based on, you know, the way practices were bought out and physicians left the area, you know, I think there was a town where 15,000 people got a message that they no longer had access to their physicians.
“And then we’ll do focus groups in Atlanta, New York, and Chicago.” – Diljeet Singh, MD
Where can physicians find the survey on moral injury, and participate?
“Come to the PNHP website … there’ll be a popup for moral injury. It’ll lead you right to the site. You can take the survey, you can share the survey, you can read about the work we’re doing and even if you don’t feel comfortable doing the survey, you can get connected in a way that we can make sure you get the results of the work we do.
“You can reach out to me through Physicians for National Health Program. I’m happy to talk to people who are engaged with health care in any way shape or form and would like to know more about this, getting involved with the work. It’s going to take all of us to put pressure on our legislators to give us what we deserve. And so please come to the website, reach out to us, we’ll connect the link in a way that makes it easy to use.
“… the survey data for this particular part [of the survey] is through the end of July, but we are going to continue to do the survey and we are going to try to make more specialty specific versions.
“So like I was talking about reproductive healthcare professionals, people in training, students and residents, that’s a really challenging space and they have a huge sense of moral injury and how that influences their decision making. We want to look at people who do a lot of surgeries and procedures and deal with more prior authorizations, you know, orthopedic surgeons, et cetera. We have a lot of work to do. So please keep coming to our website. We will keep evolving this work and we want to tell your story. – 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
Addressing Moral Distress and Moral Injury in Healthcare: Implications for Workforce Well-Being and Systemic Change, Journal of Radiology Nursing
Navigating Moral Injury: The Hidden Struggle Among Healthcare Professionals, University of Oklahoma Health Sciences
Moral Injury – National Center for PTSD, Veteran’s Administration
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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