Excessive testing forces doctors to practice 'fast and loose medicine.'
Dean said she and Talbot have given two dozen talks on moral injury."The response from each place has been consistent and surprising: ‘This is the language we've been looking for for the last 20 years.'"
These brief encounters may be good for business: They reduce the"door to doc" time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge amuch earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without"being seen," which is another quality measure.
Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for"Hallway medicine is such a [big] part of emergency medicine these days," said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are"literally stuck in the hallway.
Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they've identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.
Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.
"There was a grieving process, leaving primary care," he said."It's not that I don't like the job. I don't like what the job has become today."
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