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BackPage Online, October 2018

doi: 10.1097/01.BACK.0000546401.82141.9d
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Dangerous Injection Procedure Growing in Popularity

A New York Times article discussed the growing controversy surrounding the use of the anti-inflammatory drug Depo Medrol in spinal injections. NYT writer Sheila Kaplan pointed out that the manufacturer Pfizer asked the FDA to ban the use of Depo Medrol injections in and around the spine. “It must not be used by the intrathecal, epidural, intravenous or any other unspecified routes,” the company wrote. However, with declining levels of opioid availability in some medical systems, patients are apparently pressuring pain specialists to perform this injection procedure—despite a long track record of adverse events and patient deaths.

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Physician Burnout a Symptom of “Moral Injury?”

An article at STAT offers a provocative challenge to the notion that the impaired state of many physicians in the United States and other countries reflects classic “burnout” with its mix of overwork, fatigue, lack of resilience, and lack of joy at work. Rather, Simon Talbot and Wendy Green suggest that the state of physicians reflects a more fundamental and difficult state: “Moral Injury.”

“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.” Journalist Diane Silver described it as “a deep soul wound that pierces a person's identity, sense of morality, and relationship to society.”

“The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care,” according to the authors.

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Loss of Respect for Medical Providers

Physicians in modern medical systems have to face burnout, “moral injury”, and other aspects of contemporary medical practice. In addition, they are progressively losing the respect of their patients and the general public. Society used to have unrealistic views about the capabilities and knowledge of physicians, according them excessive consideration and respect. Half a century ago, more than 75% of men and women expressed great confidence in physicians, according to an article by Milton Packer, MD. A recent Gallup Poll found that only 36% of the general population had confidence in physicians. In terms of trust, the medical system trailed the military, small business, the police, organized religion, the presidency, and the Supreme Court in terms of trust and respect. So that trust is fading away. Physicians and healthcare systems need to address this deficit and rebuild some semblance of trust.

Here is the link to the article at MedPage Today:

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