Moral Injury V

Quiet quitting

As per a Gallup article in May 2023, quiet quitting can be defined as: “the idea spreading virally on social media that millions of people are not going above and beyond at work and just meeting their job description.”

What does quiet quitting look like in medicine?

Imagine that you suddenly wake up at night with chest pain. Your partner rushes you to the ER and the nurse greets you in a monotone voice. She tells you where to go and you are suddenly getting undressed and having needles jabbed into you by another nurse who is looking at his phone, appears irritated and does not make eye contact.

Next you meet an ER physician. She starts asking you a bunch of questions and types onto a tablet. She tells you curtly what she is going to do next, examines you, then abruptly leaves the room.

You sit waiting fearfully in the little ER area curtained off from the rest of the room. About 30 minutes later the physician comes back and tells you “you are having a heart attack”. Before you have time to process this, she wheels your bed towards the procedure room.

How do you imagine feeling after this encounter?

The nurses and physician have all done their job description in an efficient manner. They have ordered the right tests and done the right procedures. But they have not gone above and beyond to show empathy and compassion for you and your partner. They did not create a warm and safe environment. They did not make you feel like a human being who is suffering and needs healing.

Now imagine the same scenario replayed with the nurses and physician going above and beyond:

You rush to the ER and the triage nurse greets you warmly by your first name. She looks you in the eye, and tells you that the team here at the ER is one of the best and they are going to take great care of you. She explains clearly what is going to happen next and then shows you were to go.

The next nurse comes in and greets you just as warmly. He puts a hand on your shoulder and says that he heard about what happened to you from his colleague in triage. He asks if your partner would like a chair and if he can bring you both some water and an extra blanket since it is chilly today. He explains clearly what he is going to do, what the bloodwork is going to be looking for, and approximately how long it will take to be analyzed. Then he says his colleague will be coming by in approximately 15 minutes, but if you need anything in the meantime, you should press the button on the bed. He will be checking back in on you every 15 minutes or so unless another emergency comes in.

Ten minutes later, the physician approaches your bed, shakes your hand and your partners hand and introduces herself. She repeats what she already knows from her colleagues and asks what she might be missing. She asks how you are holding up, and says that she knows it can be a really scary and difficult moment to be there waiting for the lab results. She explains that they are waiting on a few blood tests, and if they come back positive, the next step would be to help your heart by putting in a little tube that opens the blood vessel. She says that this sounds complicated, but it is actually a very routine procedure and her team here at the hospital safely does this procedure twenty times a day. She asks if there is anything she can do to make you more comfortable while you wait.

Fifteen minutes later, the nurse and physician return. The physician tells you that the blood results are in, and unfortunately it does appear you are having a small heart attack. She reassures you that her team is getting ready right now to help you prevent damage to your heart. She asks if you would like to go to a private area to talk about the risks and benefits of the procedure or if it is OK to discuss it here in the ER. She clearly goes through the risks and benefits of the procedure and makes sure that you and your partner get to ask questions. Next the nurse offers to take your partner to a room to wait for you and gives you a chance to talk privately for a minute before your procedure. Then the physician and nurse return to take you to the procedure room while the nurse takes your partner to the waiting area.

How does this feel to you? In this scenario the actual medical decision-making was the same. The same job description was executed. But the experience of the patient and the loved one is entirely different. They feel seen, heard, and treated compassionately like humans who are suffering.

In the first scenario, the providers are quiet quitting - they have simply stopped showing up mentally for their patients. This is a huge risk of moral injury. When we stop feeling like humans and start feeling like robots, we are not healed.