If I Betray These Words: Moral Injury in Medicine and Why It’s So Hard for Clinicians to Put Patients First

It has been almost 2 yr since I encountered a senior anesthesiologist with an international reputation at a small anesthesia conference. This friend of more than two decades had recently changed his affiliation from one prestigious academic institution to another equally prestigious academic institution. When I asked how he was adjusting to his new professional environment, I was sad (but not surprised) to hear his dispirited response. He had been recently “counseled” (read reprimanded) for postponing an elective surgical procedure on a child who was not optimized before the scheduled operation. His “reward” for acting in the patient’s best interest was to be condescendingly lectured about the financial consequences of his “inefficient” decision. This was not the first such disillusioning episode he had experienced. We then had a lively discussion about the challenges of working in a broken, toxic, and corrosive healthcare system that prioritizes profits over patient safety and...