If I Betray These Words

Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First

De: Wendy Dean, Simon Talbot

Narrado por: Wendy Dean

Through stories and solutions, leading physicians tackle the conundrum of how best to care for patients while being thwarted by the business side of healthcare

Moves "away from calling doctors’ difficulties 'burnout'—thus blaming doctors—to 'moral injury'—like soldiers floundering under unjust orders. A brilliant expansive book.”—Samuel Shem, Professor in Medicine at NYU Medical School, author of The House of God and Man's 4th Best Hospital

“Wendy Dean diagnoses the dangerous state of our healthcare system, illustrating the thumbscrews applied to medical professionals by their corporate overlords… Required reading for all stakeholders in healthcare.”—Danielle Ofri, MD, PhD, author of When We Do Harm; A Doctor Confronts Medical Error

Offering examples of how to make medicine better for the healers and those they serve, If I Betray These Words profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.

Doctors face real risks when they stand up for their patients and their oath; they may lose their license, their livelihood, and for some, even their lives.

There’s a growing sense, referred to as moral injury, that doctors have their hands tied—they know what patients need but can’t get it for them because of constraints imposed by healthcare systems run like big businesses.

Workforce distress in healthcare—moral injury—was a crisis long before the COVID-19 pandemic, but COVID highlighted the vulnerabilities in our healthcare systems and made it impossible to ignore the distress, with 1 in 5 American healthcare workers leaving the profession since 2020, and up to 47% of U.S. healthcare workers now planning to leave their positions by 2025.

If I Betray These Words confronts the threat and broken promises of moral injury—what it is; where it comes from; how it manifests; and who’s fighting back against it. We need better healthcare—for patients and for the workforce. It’s time to act.

©2023 Wendy Dean and Simon Talbot (P)2023 Steerforth Press LLC

Reseñas de la Crítica

"A fierce denunciation of American medicine in which physicians are the heroes—mostly… An expert bottoms-up examination of our diseased health care system."—Kirkus Reviews (starred review)

“This is a great story of an adventurous and wide-ranging doctor dedicated to bringing the human into medicine. Having felt the whip of money and ‘administrators,’ in both large institutions and small hospitals, she and Simon Talbot moved away from calling doctors’ difficulties 'burnout'—thus blaming doctors—to 'moral injury'—like soldiers floundering under unjust orders. A brilliant, expansive book.”—Samuel Shem, MD, DPhil, Professor in Medicine at NYU Medical School, author of The House of God and Man's 4th Best Hospital

"A manifesto for our times! Wendy Dean diagnoses the dangerous state of our healthcare system, illustrating the thumbscrews applied to medical professionals by their corporate overlords. By making it impossible to do the right thing for patients, the profit-hungry system casually gouges the moral fiber of healthcare workers, threatening patient safety. Luckily, Dean lays out a path forward. Required reading for all stakeholders in healthcare."—Danielle Ofri, MD, PhD, author of When We Do Harm: A Doctor Confronts Medical Error

Life changing

What a journey. Thank you for giving us a voice and putting into words what so many of us feel but cannot articulate.

A must read!

Very insightful and intelligent journey that should be taken by all in healthcare and legislation. We need to do better in order to serve our patients.

Must read for all patients (that’s everyone!)

I don’t think I have ever listened to a book and then immediately started it over AGAIN.
But…. this book.
This book I read twice.

It is the sometimes tragic story of my life, my passion, my 22 year career as a physician; it describes the internal conflict I feel daily.
A conflict so intense it makes me ill.
A conflict between my desire to put patients needs first and my inability to do so.
This pain I feel now has a name = Moral Injury.
Moral Injury describes the plight of tough, resourceful, and resilient clinicians who feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.

⭐️If you want to understand why you can’t find a doctor to see or listen to you…. Read this book.
⭐️If you wonder why healthcare is so expensive… read this book.
⭐️If you are frustrated that your doctor can only spend 15 minutes with you and seems rushed and looks at the computer the whole visit…. Read this book.
⭐️If you wonder why physicians have high suicide rates… read this book.

I believe things will get worse before they get better. It will take all of us to fight for a system that allows physicians to put patients first.

“One day we will all be patients. Don’t we want our health systems to put us and those who care for us first?” - Dr Wendy Dean

Important

Few things are as important in the U.S. right now as the state and trajectory of healthcare. If you want to understand where we are, this will be one of the most accessible and informative books you can read. From this understanding, please help us find a better path.

Great!

I really didn’t expect this to be so gripping and hold my interest. But it did. Wendy Dean does an amazing job at illustrating the system failures of medicine. It is well researched, well written and enjoyable to listen to. Really superb.

Richly insightful and thought provoking

As a neurology resident, I recommend to anyone wanting to understand modern healthcare challenges

Important for Health in America

A vitally important look into what ails our healthcare system and why it’s gotten harder to get quality physician care, why physician’s die by suicide more than any other profession, and why legislative changes to date have failed to restore quality, reduce costs, or relieve strain on physicians. Wendy Dean’s book is concise, poignant and rooted in the desire to bring CARING for patients back to the center of healthcare.

Required Reading - necessary transformation

I’m so thankful to the authors for standing in the gap for patients and health care workers who have so often been abandoned by the government and health systems they work for in the name of profit. This should be required reading in every boardroom, C suite, MBA and MHA program in the country. Unfortunately, that would require for those who inhabit those spaces to recognize that patient care is the priority. Hopefully we can all work together to bring that truth back to the light it deserves. This book is an inspiration and a blueprint for those of us who care.

Relatable

Appreciated the author’s giving words to use to better understand the struggles we health care workers face on a daily basis.

Dust bowl

This is a must ready for physicians, aspiring doctors, brave healthcare administrators and ideally, by anyone who has been baffled by the inequities and illogical mess modern healthcare has become. As a physician I could relate to most of the vignettes, and at least one (“Broken”—featuring a colleague) made me horrified about what could have happened to me. The term Moral Injury resonates well and expresses what many of us have felt, more accurately than “burnout” or “compassion fatigue.” Having an accurate term helps promote self-forgiveness, and a pathway beyond the harm.

Why “dust bowl”? Well, I just kept thinking that the current trend of corporate medicine is essentially burning all the good from the practice of medicine, just as aggressive and foolish farming practices destroyed the farmland of the US in the 20’s, resulting in decades of loss and painful recovery. Is it too late for medicine to recover? I don’t know. I did retire early, though not a day goes by without me replaying concerns and frustrations that lead to my decision.

The insights in this book give me hope, and validation that I wasn’t just imagining a trend where my team—and our dear patients—were merely Revenue Generating Units.

Kudos to the authors and the brave souls who shared their stories.