Medical leaders need to take ownership of the doctors’ wellness agenda

To the Editor: Doctors’ wellbeing is an important agenda for reducing doctors’ burnout and its consequences. It is often confused with wellbeing related to personal lives that is not controlled by workplaces. My observation is that systems are implementing symbolic solutions, which undermine the efforts of advocacy for system solutions. I see wellness through my experience during teenage years, growing up in the middle of a war. I suffered emotional trauma; more than that, moral injury that was inflicted by the hypocrisy of the system that violated my human rights. Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs.1 All I wanted was for someone to stop the war; I was not expecting to be sent to a wellness officer or to wellness and resilience training workshops. In the past 22 years as a doctor, I am seeing the emergence of the term “moral injury” in health care settings and is linked to doctors’ wellbeing.1

I feel that moral injury within health care settings occurs when workers’ rights, expectations of doctors, and the organisational values and purpose are met with contradictions at workplaces.1 The literature is clear that doctors’ wellness is related to the culture and environment of the workplace rather than issues with the individuals’ resilience (Box).2

Of course, training to fine‐tune skills to manage emotionally challenging clinical situations and self‐care is important, but resilience training should not be about how to tolerate situations that cause moral injury. It will be difficult for systems to address workload‐related stress driven by doctors’ own choices. While some of the system’s problems can only be solved through organisational alignment of values and purpose, medical leaders of all levels need to take ownership of the doctors’ wellness agenda. They need to advocate for removing situations that cause moral injury and focus on cultural and structural solutions within their work teams and units, fostering a sense of belonging, cohesion and autonomy among colleagues, promoting self‐care and minimising burnout. This may create psychologically safe and joyful work teams.