The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
At a more recognisable level for us, there is I suggest another arena in which moral injury is a growing concern – the provision of health care. Moral injury of health care is not the offense of killing another human in the context of war. It is about being unable to provide high-quality care and healing in the context of health care expectation.
Our current NHS health care system and allied private health practitioners as well, find themselves unable to meet patients or clients needs and this failing has a profound impact on the clinicians and practitioner’s wellbeing especially if the reason for being unable to meet these needs is out of your control. It is this developing and expanding gap between the initial ‘calling’ of your professional life and its related desire to promote health and recovery that creates so much problem.
The matching of ethical care, moral pathways and delivery of focussed and personalised medicine or therapy is very hard in the existing structure of the dominant health care system in the UK, but also elsewhere. The resulting disconnect between intent and execution can lead to a slow degradation of joy and contentment by a series of a thousand small wounds – which overtime coalesce into the ‘moral injury’ of health care.
Whilst in the NHS a top down appreciation of the need to reassign some higher level of autonomy to primary care physicians and an allied process that permits appropriate allocation of time and other resources is a long-term solution – what could be done now, what could help you regain the feelings related to that joyful moment when you finally qualified and saw your rosy future in the delivery of health generation!
Well having a sense of purpose, a vision of a reachable and attainable state of function appears to confer health benefits and reduces stress. How to summarise this:
“it’s basically the idea that your life makes sense, you’re here for a reason, and you’re significant in the world.”
One of the significant observations we have had reported back to us over the years of training practitioners and clinicians in functional and lifestyle medicine has been the sense of re-engaged enthusiasm for their chosen profession – stress is reduced, joy is revitalised when the skills recently learned allows them to re-engage with their inherent purpose.
In turn, these re-invigorated professionals also re-engage in self-promoting behaviours, change eating, exercise and resting profiles and take their new enthusiasm to their patient groups catching many new converts and completing the circle of purpose discovery.
As Nietzsche once wrote, “He who has a why to live for can bear almost any how”.
If you are already on the path of a clear purpose, then well done, your life span is anticipated to be longer and healthier, your tolerance of challenge better and emotional stability more assured. Look out for colleagues for whom moral injury is taking a powerful place in their life, see if a retraining may offer them a way forward and help them rediscover purpose – it’s a gift of immense opportunity.
Are you a cat or dog person?
– why is this of any interest to you as a practitioner and why would you care other than if you are bonded with one or both of these species? Well, it seems that there is a cat dependent parasite that has the ability once you become its host to potentially alter your thoughts and moderate perception of risk and whilst this has been known for some time in terms of its manipulation of its host (mainly rodents) to ensure progeny – more and more data suggests it also impacts on human thoughts and patterns of action!
Its common, wide spread and likely if you are a cat lover to be invested in your survival right now! Read the rest of this entry »
The unspoken concern of many people in their middle age is the loss of cognitive function, resilience and flexibility. If you are watching family or friends become detached from their environment, memories and independence you will already know that this process is distressing and challenging, as all associated parties are also pulled into the complications and care. Read the rest of this entry »
Whilst it may seem a strange combination of subjects, there is a connection. For people to maintain social engagement and interaction where ‘belonging’ is a natural and desired outcome there needs to be some cohesion, a ‘sticky’ thing that provides the glue that we require and need for the generation of health and contentment. Fibre derived from our diet in the form of fermentable compounds fills the same role for our dominant occupying population, who are also dependent on communication, interaction and social bonding – yes, the bacteria, viruses and other organisms residing in your gut. Read the rest of this entry »
If you have ever felt exasperated at the resistance to change in personal behaviour that would alter the trajectory of someone’s choices, health and wellbeing, you are not alone.
Hundreds of books, thousands of articles, millions of consultations and trillions of frustrated inner thoughts have been presented as solutions, explanations and disillusionment. So, what we are saying, is you are not alone. Indeed, you may be someone that finds internal rationalising easy and yet finds the momentum needed to change your own behaviour to alter your life’s trajectory impossible – so how do we engage people we have been asked to help to make and sustain positive change? Read the rest of this entry »
If the purpose of your professional life is to induce the induction, management and sustainability of health and vitality, not simply the absence of disease, you must first look in, and then project out.
The establishing of a core set of principles that shape, and in part define who you are will be determined by various intersecting influencers, life related experiences and the learnt or inherited ability to critically review and appropriately contextualise these values. Read the rest of this entry »
How do you make decisions, not just in clinical work but in life? Do you ponder, obfuscate, data gather endlessly, look for hints or clues, match outcomes with risk benefit analysis or have a random set of parameters that are defined by mood and time?
Do you qualify decisions based on an abstract level of importance or keep a mental decision tree in your head that allows a structured approach that you have become reliant upon; are these processes knocked off course by emotion, stress and wellbeing or ultimately led by these? Read the rest of this entry »
The process of life creation is one of nature’s great wonders, none more so than in the creation of new humans. This process seemingly unhindered for thousands of years has produced a global expansion in population numbers of billions. Today 384,701 people will be born and 156,936 people will die, resulting in a net gain of 227,765 humans (give or take a few thousand). This year 140 million babies will be born and 57 million people will die and with each new life comes opportunity and risk. Read the rest of this entry »
Recently there have been several early stage developments in the delivery of changes to medical education, namely the recognition of the absence or insufficient knowledge on the role of nutrition in the management and reversal of complex non-communicable diseases. Read the rest of this entry »
Mostly, as practitioners focussed on the responsiveness of the innate and acquired immune system in the gastrointestinal tract, the circuitry of interest has been associated with the transmission of messages from the gut to the brain – so much so that the information in the other direction has been largely ignored or diminished in clinical relevance. Read the rest of this entry »