What is moral injury?

April 17, 2019

How hygienists are being hurt by the intense pressure to make money.

Are you at risk of a “moral injury” just by doing your job? I interviewed a hygienist this week who really opened my eyes to this concept. Talking to her and researching this was a bit frightening, but it’s something we should all be thinking about. So, what’s a moral injury?

The Moral Injury Project at Syracuse University defines moral injury as “The damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.” Think of this in the context of veterans or someone coping with post-traumatic stress disorder. If you’ve been put in positions that create conflict internally, this may be a moral injury to you. That stress you’re feeling may have this name.

Most of us came into this field because we care about helping other people. We weren’t driven by money, but several have written about the unrelenting pressure to generate income for the practice. Upselling increases profits. In all the years I’ve written for this industry, I’ve been cautious about this issue. Editors haven’t wanted to upset dentists and specialists, but there’s a huge elephant in the room that must be acknowledged. That elephant is whether we’re hurting our staff by the intense pressure to make money.

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The politically correct answer is “Absolutely not! Why would you even suggest that?” I’m not trying to be negative, but I do like to deal with reality. I saw this same issue of moral injury in healthcare as a social worker for 20 years, but there wasn’t a term for it. It was viewed as depression or anxiety. Today, there’s more and more pressure to make money. I’m not arguing that; this is a business. The problem is when you have unethical behavior forced on you in order to generate more revenue. This is what must be looked at. We’re hurting those who work for us.

Schedules have been tightened. “Do more in less time” is the new mantra. For some, it’s difficult to take vacation time. For others, sick time has become an issue. Hygienists have been told to come into the office when they’re not feeling well because there are patients on the schedule. (I don’t know about you, but I really don’t want a hygienist working on me who has a cold or the flu. Going to the dentist shouldn’t make me ill, right?)

Insurance dictates so much nowadays. You can’t do tests multiple times, such as having an X-ray taken more than once a year, and you have to make sure one procedure doesn’t come before another even when it’s in the patient’s best interest. Otherwise, it isn’t covered by insurance.

Another issue is having different dental licensing boards from state to state. Why isn’t this a centralized process? Fortunately, the Arizona governor recently signed legislation to make the state the first to automatically grant occupational licenses to those who move there and have an unblemished credential from a different state. This is progress, and we’ll be watching.

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Hygienists should be recognized as the professionals they are. They’re not the “cleaning ladies.” Rather, they’re the ones evaluating inflammation, checking on the quality of home care, screening for oral cancer and signs of sleep apnea, and trying to help you improve your health and life.

One hygienist said she took her elderly parents to the doctor recently. The doctor asked about when the last eye, hearing and foot exams were. She never asked about when the last dental visit was, even after looking into her parents’ mouths to say, “Ah!” If your teeth and gums aren’t healthy, you can’t eat well to provide your body adequate nutrition. Shouldn’t this be a standard question physicians ask every patient?

My point is that hygienists are professionals who need to be respected more by the dental team and their patients. They’re trying to provide the best care they can, but inflicting moral injuries on them by pressuring them to cut corners and upselling all in the name of money is quite distressing. Maybe the question really is are you on medication because of stress on the job in your dental practice? Don’t you think it’s time to do something about this and take care of our hygienists?

If you agree or disagree with the concept that moral injury is happening in the dental practice, please email me at diana2@discussdirectives.com.