Abstract
BackgroundMedical progress, economization of healthcare systems, and scarcity of resources raise fundamental ethical issues. Physicians are exposed to increasing moral conflict situations, which may cause Moral Distress (MD). MD occurs when someone thinks he or she might know the morally correct action but cannot act upon this knowledge because of in- or external constraints. Correlations of MD among residents to job changes and burn-out have been shown previously. There are, however, hardly any quantitative studies about MD among physicians in Germany. The aim of this study was to investigate the frequency of occurrence, the level of disturbance, and reasons for MD among neurological residents in German hospitals.Methods1st qualitative phase: Open interviews on workload and ethical conflicts in everyday clinical practice were conducted with five neurological residents. Ethical principles of medical action and potential constraints that could cause MD were identified and a questionnaire designed. 2nd quantitative phase: A preliminary questionnaire was tested and evaluated by five further neurological residents. The final questionnaire consisted of 12 items and was conducted online and anonymously via e-mail or on-site as part of an unrelated resident training event at 56 sites.ResultsOne hundred seven neurological residents from 56 university/acute care and rehabilitation hospitals throughout Germany were examined (response rate of those requesting the questionnaire: 75.1%). 96.3% of the participants had experienced MD weekly (3.86, SD 1.02), because they were unable to invest the necessary time in a patient or relative consultation. Errors in medical care, which could not be communicated adequately with patients or relatives, were rated as most distressing. The most common reasons for MD were the growing numbers of patients, expectations of patient relatives, fears of legal consequences, incentives of the DRG-system, and the increasing bureaucratization requirement. 43.0% of participants mentioned they considered leaving the field of inpatient-care. 65.4% stated they would like more support in conflict situations.ConclusionMD plays an important role for neurological residents in German hospitals and has an impact on participants’ consideration of changing the workplace. Important aspects are rationing (time/beds) and incentives for overdiagnosis as well as lack of internal communication culture and mentoring.
Highlights
Medical progress, economization of healthcare systems, and scarcity of resources raise fundamental ethical issues
Forty-eight chief physicians passed on the request to participate to their neurological residents, of whom 98 residents agreed to participate via e-mail
This study shows that neurological residents in Germany regularly suffer from Moral Distress (MD) in their daily work life
Summary
Economization of healthcare systems, and scarcity of resources raise fundamental ethical issues. MD occurs when someone thinks he or she might know the morally correct action but cannot act upon this knowledge because of in- or external constraints. MD research can generate knowledge on two levels: On the one hand, it reveals new aspects of mental health and job satisfaction of health care system workers: Physicians who experienced MD in their daily clinical routine suffered significantly more often from symptoms of depression [4] and burn-out [5]. The MD concept highlights the constraints and conflict situations which lead to MD. It can, provide insights into problem areas and deficits of a health care system and subsequently into potential of improvement. While the main reasons of MD in Iran were lack of medication and medical equipment [7], physicians working in intensive care units in the UK suffered mostly from futile medical treatment [6]
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