EPISODE: 9
Moral Injury
Impacts Physician Moms too
with guest Jennie Byrne MD, PhD
InspiredMomMDs.com/9
Understanding Moral Injury in Physician Moms: How to Recognize It and Begin Healing – guest Dr. Jennie Byrne MD, PhD
Episode 9: : Moral Injury Impacts Physician Moms too, with guest Jennie Byrne MD, PhD
I’ll be honest, the term “moral injury” is new to me this year. In the climate of discussion around the burnout phenomenon, moral injury is both an intriguing and a refreshing term.
In a moment of synchronicity, I was listening to a podcast by Katrina Ubell, MD on my drive home from work at the same time a notification popped up on my LinkedIn about a new book on moral injury.
Today my guest is the brilliant physician mom who sent that LinkedIn post, Jennie Byrne, MD, PhD. As an author she just released her second book called Moral Injury: Healing the Healers (2024)
Dr. Jennie is so many things to so many people! She’s an:
- Expert in her field as a
- Psychiatrist
- Healthcare executive
- Coach and psychotherapist
- Mom of 2 teenagers
Keep reading for our discussion and her expert insight on moral injury and how to heal the healers.
Dr. Cindy:
Good morning Dr. Jennie. I am so excited to talk with you today.
Dr. Jennie Byrne:
Thank you, so happy to be with you.
Dr. Cindy:
I want to briefly summarize your professional background for listeners before we dive into today’s topic. Here we go. You have a dual background as an MD, PhD in neuroscience and psychiatry, which gives you a unique perspective on the biological and psychological aspects of human behavior and health.
You use that knowledge to work as an advisor for multiple healthcare innovation companies transforming the delivery and quality of mental health care.
And you’re a seasoned entrepreneur and you’ve worked as a national C-level leader creating and innovating clinical programs.
You also practice as a psychiatrist specifically caring for other physicians in areas including depression, anxiety, ADHD, burnout, and moral injury.
And lastly, you are a thought leader in the healthcare community and a best-selling author of your first book Work Smart. A book on how to use your brain and behavior science to work smarter.
And this brings us to your new book release moral injury, healing the healers. Did I get all of that right?
Dr. Jennie Byrne:
You did. It sounds like a lot when you say it like that.
The Difference Between Burnout and Moral Injury in Physicians
Dr. Cindy:
You are so accomplished!
I did download your e-book. And I read it all, cover to cover, virtually speaking. And I highlighted so many pages, but in particular, I was looking for the distinction between burnout and moral injury. Can you please explain the difference between those two terms?
Dr. Jennie Byrne:
Sure. And I think as I’m describing it, if you have in your mind, kind of a Venn diagram, you know, they definitely have some areas of overlap. But there are also times when you may be burned out without moral injury, and their times you may have moral injury and you’re not burned out.
Burnout has come to mean a lot of different things. People use it a lot. It’s in the lexicon, there’s a lot of buzz.
Moral injury is a term that most people aren’t familiar with. And it comes from the military experience.
As I was researching for this book, trying to figure out you know, what’s wrong with our healers like something is wrong, something is wrong inside and burnout didn’t seem to capture all of it. So, I learned about the concept of moral injury. And what it says is three things.
First, that you either do something or witness to something or part of something that goes against your values, which could be personal or professional values or ethics.
Number two, that it is ordered or condoned by a superior of yours.
And then number three, the stakes are high.
So, you can imagine, you know soldiers coming back from deployment, it’s not really PTSD. It’s not really depression like something else is going on. And this described this kind of wound on their soul, almost.
When I think about healthcare, I’m what we’re so many of the healers are feeling inside to me this just resonated immediately that this deeper feeling of this wound, it’s more of a wound.
To me, burnout is like a low energy state. It’s very industrial.
You know, you have a light bulb, it’s burned out, you go get a new light bulb, you plug it in, and I feel like that’s the message for health care providers is like well, just you know, go take a vacation, take a sabbatical, you know, to go do some yoga during your lunch and like you’re just put that back in and that doesn’t really seem to be working.
Dr. Cindy:
Exactly. I hear that too. So, burnout is sounds like something that could be a quick fix, whereas moral injury, if it’s a wound to your soul, that isn’t a quick fix.
Dr. Jennie Byrne:
Well, I in the book, one of the metaphors I use that I liked was kind of this idea of staging a wound. So a lot of us are familiar with that concept is that you know, physician or nurse or others you may have these wounds that you stage.
So, if you have a very superficial stage one, moral injury might not be that hard to fix. It may be a vacation, some support, some talking to peers, maybe that’s enough. But once you start to get down to the bone stage four you know, it’s really hard to heal those kinds of wounds that can be healed, but like you said, it’s not a quick fix.
Dr. Cindy:
Right.
Physicians Value Autonomy
Dr. Cindy:
You mentioned that with moral injury the stakes are high as they are in medicine, often. A superior is telling you, essentially, kind of what to do. And what you are doing is going against your values, your core values.
You’re going against what you want to do. You’re a little bit out of control in a sense, so why do clinicians value autonomy so highly?
Dr. Jennie Byrne:
I think this is fascinating. When I work with companies, they really struggled to understand this concept. They really struggled to understand why clinicians value autonomy but if you think about it, physicians in particular that’s our whole training.
You know, our training is still this model of like, you know, you’re kind of responsible for everything. And you have autonomy, you have kind of the highest autonomy to make life and death decisions for people and it’s all on your shoulders.
So, if everything is on your shoulders, you darn well better have control over it as much as possible because if you don’t have control and you have all the responsibility, that is that is a very distressing situation to be in.
I think that a lot of people fail to understand too, that autonomy sometimes is a feeling and not an operational — like we don’t actually want every choice in the world open to us. It’s overwhelming.
As a physician. We don’t really want to have 6000 medications to prescribe for one condition. No, that’s too much.
We want a curated list and the autonomy to decide what to prescribe without a prior auth telling us no you can’t without, you know the boss telling you no you can’t prescribe that oh, it’s not on formulary, blah blah, blah, blah, blah.
So, autonomy is a feeling and I think people don’t understand that the way to generate the feeling of autonomy is not to give people every single choice in the world. That’s not what autonomy means. It means for the critical decisions that really matter, making sure you have that kind of choice.
Dr. Cindy:
Right so that so as a physician in a specialty, we have a zone that we’re in, like you mentioned, you don’t want to have you don’t want to have that all the choices in the world, you want to stay in your zone but have the choice to move back and forth and zigzag and do what you think is right for the patient.
Dr. Jennie Byrne:
And that’s what most clinicians will say autonomy means to them, I want to do what I think is the right thing for this human being in front of me without worrying about all the other things that are swirling around.
Dr. CIndy:
Right.
How Can Patients Support Their Healers?
Dr. Cindy:
One of the points in your book, which is something that is a good reminder, is that even though we are physicians, and the audience are physicians, we are all patients at some point. How would we as patients or anyone else listening today, support our healers?
Dr. Jennie Byrne:
You’re exactly right. And I know you work with a lot of moms in particular. So, if you’ve been pregnant and had a baby or you have a child and you go to the pediatrician or you know you are a patient, right just we all are at some point.
Some of the advice I give in the book is, you know, as the patient what can we do?
I think the first thing that we can do is very simple, which is just to be kind.
Okay, give your you know, give the clinician give your provider the benefit of the doubt, you know, they’re running, you know, two hours behind schedule. Odds are that they don’t feel great about that.
They probably feel guilty and ashamed, and you know, as a physician, if I’m running late, I feel awful inside I feel guilty and ashamed. So, benefit of the doubt.
There’s one phrase I think that we can all use, that goes a long way because I know it touches my heart every single time somebody says it to me, which is “thank you for all you do.”
And that really, it’s not just what you did for me as a patient but like, I know that as a physician, you’re doing a lot of stuff behind the scenes, you’re struggling with a lot of stuff and I know I’m just happy you’re there, and I’m happy you’re doing this work.
And those phrases may seem trite, but they take a second and they touch you at some level.
And I think if nothing else, we can say things like that or another phrase that really gets to the heart of thanking people for what they do.
I don’t think physicians ever really got thanked after COVID pandemic and I heard this a lot in my interviews like you know, yes, we had to be quote unquote heroes and all this and then at the end of it there was like, kind of nothing. It was like just go back to work, and it was like we needed something not we don’t want to be a hero necessarily, but some recognition of that and some thinking and some, some respect.
I think this feeling of respect is missing. And a lot of us went into medicine, not expecting to be billionaires, but we did expect to be respected. I did, I’m sure you did.
And when we don’t get respected by patients or by others, it’s really hard. Because that’s, you know, we sacrificed a lot in our 20s to get here and then not to be respected in your community or in your own house.
Or you know, when you work with a lot of moms, I don’t know what they’re going through, but you know, to be a physician mom and then come home and expect that like you’re going to put dinner on the table every night and it’s going to be nutritious and wonderful.
To me that’s just like a very unrealistic expectation that is put and, and a lot of physicians have this culture of being stoic and you just put your head down and you just do it and you don’t question things. But to me, that’s a lack of respect.
You know, I have to say especially for moms the societal expectation that a physician mom is going to do all these things. I always ask myself, like if I were a man with the same expectation be there and if the answer is no, then that’s to me a flag like I should go deeper and see what’s going on here.
Dr. Cindy:
Exactly, so many good points that resonate with me. And also, you know, with physician moms that I’ve spoken to who mentioned essentially feeling like they need to be superwoman, like you’re saying do it all and not need to ask for help and do it all right the first time.
Also going back further to when you said, I don’t think it’s trite, the comment you said “thank you for all that you do” is so powerful.
I recall the very first time someone said that to me, and it’s just, it just takes seconds to say it. And this was maybe a couple of years ago and it had such an impact on me. So, I think you’re really on to something which is the simple heartfelt thank you to clinicians that you encounter for all that they do. Just beautiful.
Dr. Jennie Byrne:
If nothing else, you know, if you had one or two people a day that came into your office or your virtual office and said that to you. That’s a Band-Aid I mean, it’s a Band-Aid to moral injury, but it is a salve right, like you know again, if your wounds are superficial, sometimes that kind of support from your environment is what heals you.
So, it doesn’t cost anything. I mean, obviously, if it’s not sincere, don’t say it, but it doesn’t cost anything. It takes a second and I think it’s grossly underestimated the impact that kind of thing can have.
Peer Support Among Doctors is Powerful for Healing
Dr. Cindy:
Right. And I think that pulls in a bit of something you talked about in your book about the almost the sense of community or healing through like a community with others. And can you speak a little bit more about that? It is beautiful too.
Dr. Jennie Byrne:
Sure. So, the concept of moral injury that came from the military they also have how to heal it. And one of the first things is to recognize it, call it by its name and then to support one another.
And its peer support that is the most powerful.
So, if I’m a psychiatrist if I have another psychiatrist at my you know, kind of general practice area that supports me, that is even more valued than like a primary care colleague of mine who might support me.
So peer support really goes a long way. And I found writing this book, I think one of the things surprised me a little bit was that, you know, I interviewed 30+ clinicians.
Many of them wrote back to me afterwards and said, “Wow, I shared this story with you. I haven’t really shared this story with people. And it really was healing for me just to do the interview.”
And then I was writing, and I wrote some personal stories that were really painful and super vulnerable. And I was like, I don’t know, I don’t know if I should put this in the book. But I did and like for me writing my story and telling my story was also healing.
So, writing it or telling someone or just that bearing witness again. You know, this sounds very “shrinky” I’m sure for folks who aren’t psychiatrists, but this is what we do. We just don’t turn it. We just don’t turn that perspective on ourselves.
But there’s tremendous power in healing and I know with what you’re working on in groups, and there’s some other folks having these kinds of healing groups. It’s kind of surprising, you know, when you think about back in residency, and there was a lot of power and having that group of residents together, right, when you supported one another and that collegiality.
I think a lot of people don’t want to leave academic medicine because it seems like there’s more of a collegiality available, which may or may not be true these days, but that feeling of you know, you had your resident class, you probably have like a couple of friends. I had a couple good friends and I mean, we went through really hard stuff together and that support.
I mean, I still can call up my friend today, you know, however many years later, and it’s like, you know, he’s always there for me, and I’m always there for him. And there’s such power in that.
And I think we, you know, we put our head down, you know, we’re all about put the head down, do the work, be stoic. Do it all yourself and we forget that we’re just you know, we’re human like everybody else, that really shouldn’t be a surprise.
Word of Wisdom for Physician Moms
Dr. Cindy:
Right, and I think a lot of women who are physician moms are trying to just do it all themselves, but that just that moment when they stop and talk to somebody, they just feel this relief come off their chest. And you’re just perfect — on to something.
In the in the final few moments. For physician moms specifically and you are a mom, too. I mentioned earlier,
Dr. Jennie Byrne:
I have two teenagers.
Dr. Cindy:
Yeah, so you’re right in the thick of it. I have two teenagers also. For physician moms specifically, do you have any final words of wisdom on navigating their own moral injury?
Dr. Jennie Byrne:
Yeah, I think for me, as a woman physician, the layer of injury that I don’t see for male colleagues is around this what I feel like as a lack of respect.
That’s how it shows up for me but this kind of like societal expectation that I should be, you know, wifey or “mom-ey” or like what does that mean? And then this expectation that somehow, I won’t go as far in my career, I won’t make more money than my spouse or I am not as much a powerhouse or that I can say no, and I can say I don’t want to do this stuff at my house or like, there’s this weird expectation all around.
And not just, it’s kind of like maybe death by 1000 paper cuts kind of moral injury. Like every time someone sends me a recipe. I’m like, I don’t cook. I never cooked. I don’t want to cook. I have somebody delegated to cook for me. Stop sending me recipes, that’s kind of like a dig.
Or when my kids were born, I did not want to stay home on maternity leave. I did not like babies. I love my children, but they to me were boring. I didn’t want to be at home. And so, I wanted to go back to work.
And it was this constant kind of these digs about like, oh, what are you back? Oh, you know, oh, you can take more time and know what you know. And it’s just kind of these constant digs.
When you’re at the leadership level, if you have physicians in your group, you know, it’s when I’m on a phone call with male colleagues and somebody calls me by my first name but then calls the men by Dr. So and So.
That one makes my head explode and I have to then decide, am I going to make a big thing about it, and call them out? Even though they probably didn’t mean to do it. I gotta call them out like it’s on me to fix this. That happens all the time.
I struggle whether to use “doctor” when I talk to people because I’m a very first name kind of person. Like I’m not overly stiff and formal. But at the same time, if I don’t say doctor or I don’t put MD, PhD after my name, I find that people forget that I’m a doctor.
So, I kind of have to like put these degrees up and put these things in my name. So that’s like a dig, right? There’s a lot of that stuff to me for women.
I guess my parting words of wisdom would just be, you know, you are not helpless.
Being a physician means that you have opportunities. Being a physician means you probably have a little more money in the bank. You can make choices,
I have made a choice to have a household employee. That means there are things I don’t do my kids don’t go to private schools, for example, that lets me pay for the housekeeper. The housekeeper does the cooking and the cleaning.
You have these choices available to you and then you choose what is right for you. Maybe you love to cook and that brings you joy; you should totally cook but you have these choices.
And don’t let society pressure like try to tell you you don’t have choices or make you feel like you’re helpless because you’re really not helpless. You really have autonomy and choice.
You just have to kind of, you know, be willing to open your eyes to all of the possibilities and then to ignore the pressures that are just going to come at you from all directions, frankly, you know, even from people who mean well, they’re just going to constantly dig at you.
Dr. Cindy:
So, well put, I won’t even try to summarize.
So, as we wrap up, if people want to reach out to you, maybe even you know, as a psychiatrist or just to reach you, how can they best reach you?
Dr. Jennie Byrne:
Yeah, honestly, the best is LinkedIn. That’s the only social media outlet I’m on. You can connect with me and just send me a message there.
I do see physicians who need help. And if that helps, it turns out to be a medication. You know, I think I can see 12 or 13 states I can help people in that manner.
If someone is looking for a major life pivot, and they want more of a coaching experience. So, I really just would say reach out to me.
If you’re interested in moral injury, check out the book, just to kind of learn more. But I’ll do my best. If I can’t help you, I will always respond and always try to connect you with somebody who can. Okay,
Dr. Cindy:
I’ll put your LinkedIn link in the show notes and your book as well, “Moral Injury: Healing the Healers.” Fabulous book. Fabulous.
Dr. Jennie Byrne:
Thank you for reading it so quickly. Back-to-back, that’s wonderful.
Dr. Cindy:
It was easy because I loved it when I get into something, I just devour it. So that’s how it was for me.
I wish you all the best and thank you for all that you do. Truly, from my heart I’m saying that. And I just thank you so much for talking with me today.
Dr. Jennie Byrne:
Thank you and same out there to you and all the physician moms listening thank you for all you do. It’s you know, I get it. I appreciate you and hopefully you’ll have a little kindness in your day.
It’s time to take control and thrive!
Show Notes:
Contact Dr Jennie Byrne on LinkedIn.
Her new book is Moral Injury: Healing the Healers.
About Cindy Van Praag, MD, NBC-HWC
Wellness Advocate for Physician Moms
Cindy talks about the current climate of practicing medicine while juggling the roles of mom, wife, daughter, and more. She brings a fresh pair of eyes and guidance for common situations physician moms face daily. In Inspired Mom MDs Podcast, Cindy delivers a fresh perspective and actionable steps to take agency and elevate your power. Listen on your favorite podcast app!
