Such a dramatic crisis is playing out in the medical community of New South Wales. Doctors too are suffering from moral injury as a result of chronic understaffing, low pay, and unsustainable workloads. Dr. Michael “Robby” Robinavitch, the most senior physician at the local hospital, has become iconic of that fight. He recently faced the heartbreaking decision to divert medical resources from a critically ill colleague, Dr. Adamson, who tragically died from COVID-19 complications five years ago, to a younger patient in urgent need.
It is no exaggeration to say that the medical landscape in NSW has changed dramatically over the past few years. Doctors and nurses are truly living these emotional dynamics of their profession on a day-to-day basis right now. Meanwhile, impacts from systemic decline are still becoming increasingly apparent. Dr. Robby, along with his colleagues, is experiencing trauma from working in emergency rooms where limited resources force them to make impossible choices daily.
In April, doctors working in public hospitals in NSW put their foot down. They then walked off the job for three days to protest the conditions—unsafe, insanitary, and inhumane—that they work under. The arbitrary move ignited a firestorm of outrage from physicians and other healthcare providers. Most of them have been quitting en masse from the public health system. In January alone, 200 psychiatrists walked out on their duties, stating that the cuts had made the job impossible due to chronic shortages and burnout.
The Impact of Moral Injury
Moral injury defines the anguish soldiers feel coming back from the battlefield. Today, it is an astounding $1.4 trillion dollar, yet one of the most troubling and growing problems in medicine. Professor Pat McGorry, a leading psychiatrist, has addressed how this phenomenon affects healthcare workers. He explains that moral injury occurs when professionals find themselves unable to uphold their moral and ethical standards due to external pressures.
“It’s like working in a third world sort of environment, to be honest — the moral injury of turning away seriously ill people every day and not being able to provide the care that people need and could benefit from.” – Professor of psychiatry Pat McGorry
We know, because Dr. Robby and his peers have seen first-hand the destructive impact of this moral stress. This effect is even more acute in the emergency department, where decisions need to be made quickly, sometimes with incomplete information. The commitment to serve and the inability to provide the care that’s needed has resulted in deep sadness for those on the front lines.
“This place will break your heart.” – Dr Michael “Robby” Robinavitch
The psychological ramifications go further than the individual healthcare worker. One survey by the Royal Australian and New Zealand College of Psychiatrists revealed a worrying pattern. An astounding 94% of Australian psychiatrists report that workforce shortages are damaging patient care. In addition, 82% of them reported these shortages as a leading cause of burnout.
Resignation and Burnout
The acute crisis has led many other healthcare professionals to walk out of their jobs or take other forms of action against unsafe conditions. Dr. Robby joins these struggles with innumerable other family doctors, nurses, midwives, and specialists. Collectively, they’ve signed group letters and marched in the streets to raise awareness of their concerns over the last few years.
Three out of four psychiatrists suffer from burnout. This is a shocking statistic and indicative of the desperate need for widespread systemic reform. The overwhelming workload paired with understaffed offices has created a sense of amazement and demoralization by a lot of this work.
“We did our best with the resources available, but it wasn’t enough.” – source not specified
These sentiments reflect a growing consensus among healthcare professionals that immediate action is necessary to address the underlying issues plaguing the medical field in NSW.
A Call for Systemic Change
To prevent further resignations and improve patient care, stakeholders must develop a comprehensive plan that addresses the systemic issues within the healthcare system. Recognizing the depth and impact of burnout and moral injury is key to establishing a positive environment to protect our medical professionals.
We would argue that in the current context of COVID-19, healthcare workers are subjected to extreme moral stressors on a daily basis. This has created a heartbreaking dilemma for many doctors and nurses. They, just as much as any zookeeper, have to repeatedly deny life-saving treatment to patients who do not have enough of a prognosis to deserve it.
“In the context of COVID-19 a severe moral stressor would be, for example, a healthcare worker having to, due to lack of resources, deny treatment to a patient they know will die without that treatment.” – guide to moral stress among healthcare workers during COVID-19
As the medical community continues to confront these challenges, experts emphasize the need for policies that prioritize mental health support for healthcare workers while addressing workforce shortages.
