Patient wellness is linked to physician wellness

In our first special issue on moral injury and physician wellness, we highlighted the critical importance of speaking up, especially in the face of moral injury and burnout along with stressors for the pediatric rehabilitation physician. ¹ Speaking up remains vitally important in combatting moral injury and facilitating physician wellness. In our second issue on moral injury and physician wellness, we highlight continued struggles faced by physicians in medicine. In the book, “The People's Hospital,” heartbreaking dilemmas and exhaustion are faced by medical staff at a “safety net” hospital where stressors of hospital bureaucracy, high patient volumes, and large numbers of indigent and uninsured patients contribute to moral distress, burnout, and staff suicides. ² In addition, we also highlight the impact of the pressures of medicine not only on physicians, but also on families of children with disability. The article, “Experiences of families of children with SMA and the healthcare professionals supporting them during the COVID-19 pandemic: a nationwide study,” identifies the stress experienced by families of children with spinal muscular atrophy with continually needing to qualify via physical function testing to continue life altering treatment with nusinersen, a costly medication. ³ The stress and pressure experienced by the families was also noted by providers administering these high stakes tests. Stressful and high stakes tests are frequent for children with complex medical diagnoses, with these stresses contributing to mental health disorders, as evaluated in Assessment of mental health and quality of life among children with congenital heart disease. ⁴

Maintaining resiliency while adapting to an ever-changing medical environment and medical treatments is a constant battle. For some, early exposure to other challenging experiences may foster resilience. In the book “Appetite for Risk: What it is, Who has it, and How I survived”, the author, Robert R. Abbott, encourages exposure of children to diverse and challenging experiences to facilitate awareness and preparation for managing challenging experiences as adults. ⁵ For children with disabilities and their caregivers, these challenging experiences often arise on a daily basis. Supporting children and families with disabilities requires time and thoughtful solutions. Families frequently look to their physician for guidance in both medical and psychosocial needs. However, due to the complexity of the patients and medical system, we are often left feeling rushed and limited in the solutions we can provide. Even in these disconcerting situations, having time for empathetic listening and follow up to support families is important. Yet, this simple and powerful act of time is difficult to find in medicine. In the article The Salaried PM&R Physician, discussion of the benefits and downsides of being a rehabilitation physician in a salaried position are discussed from the point of view of an adult provider and pediatric provider. ⁶ One of the notable benefits to being a salaried physician is time with patients and time for clinical problem solving.

Beyond building resiliency or increasing patient appointment duration, another potential aid to combating burnout and moral injury in medicine may be artificial intelligence (AI). Some providers are currently using AI to help with appeal letters for insurance denials and letters of medical necessity. However, there is more that AI may be able to do to optimize workflow and reduce other non-clinical work. Despite these positives, a barrier for many physicians is understanding what AI is, especially as the lay press and social media place emphasis on the negative aspects of this technology. In the book “The AI Revolution in Medicine: GPT-4 and Beyond,” the author provides an approachable overview to AI, along with impact and uses in medicine. ⁷ This includes the need to balance the use of AI with maintaining physician autonomy and physician expertise. A future that includes AI is here regardless of physician readiness for this technology. Working with and training AI for practical use in the complexities and nuances of pediatric rehabilitation medicine may promote functionality with hope that leveraging this technology can reduce physician burnout.

We are committed to identifying issues that contribute to physician burnout and moral injury. We remember Dr Jacob Neufeld, pediatric rehabilitation physician and founder and editor of JPRM, for his passion and insistence on the best care for all patients. This insistence contributed to the moral injury he experienced, his despair, and suicide. His untimely and preventable death has unified us to combat the forces in medicine that contributed to his death. As a unified voice, we will advocate for mechanisms to eradicate physician moral injury. As a unified voice, we can promote the need to address physician wellness in hospitals, medical practices and health systems. Critically, many of the issues that negatively impact physician wellness, contribute to moral injury, and foster burnout are also issues that contribute to significant stress and dissatisfaction with the medical system by patients and caregivers. Thus, reducing moral injury and improving wellness for physicians in their medical practices also improves the medical experience of patients and their caregivers.