Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care

Abstract

BackgroundFamily physicians (GPs) working with patients experiencing social inequities have witnessed patients’ healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress.AimTo explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities.Design and settingA critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada.MethodTwenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts.ResultsFamily physicians’ accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources.ConclusionThis study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians’ professional quality of life, potentially improving retention.

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies

“…Shortage of resources, like appropriate equipment or medications, and personal protection materials is described as a source of distress because it hinders the ability to care properly for patients whilst also protecting oneself. Shortages in human resourcing has an impact on individuals’ workload and therefore is an indirect cause of distress [e.g., 38 , 42 , 45 , 71 , 78 , 82 ].…”

“…Study sites were always indicated, North America and Europe, specifically England/UK were represented more than other regions. Studies were conducted across a number of different healthcare systems from the non-universal insurance system of the USA [ 40 – 42 , 44 , 48 , 57 , 62 , 63 , 69 , 76 , 78 , 85 , 87 ] to universal government-funded health system (single-payer) of Italy [ 43 , 64 , 65 , 67 , 86 ], UK [ 6 , 46 , 51 , 66 , 68 , 72 , 74 , 77 , 81 ], Sweden [ 45 ], Canada [ 47 , 49 , 52 , 54 – 56 , 61 , 70 , 71 , 73 , 75 , 79 , 82 , 84 ], Norway [ 58 – 60 ] and Australia [ 50 ], to the universal private health insurance system of Netherlands [ 39 ], and the universal public insurance system (social insurance) of Romania [ 53 ]. Although clear themes emerged that related to different healthcare systems and funding mechanisms for care (e.g., what is available to the individuals in that system based on resources and guidelines), overall, descriptions of events which could cause moral distress showed some consiste...…”

“…Sixteen articles [ 38 , 46 – 48 , 51 , 57 , 62 , 63 , 65 , 66 , 71 , 77 – 79 , 82 , 85 ] specifically explored the role of CoVID-19 in HSCW and contribute to the identification of themes summarised in categories and sub-categories ( Table 3 ). The pandemic appeared to impact the deployment of staff to various roles and clinical contexts.…”

“…Thirty Nine studies [ 38 , 41 – 49 , 51 , 54 – 60 , 63 – 71 , 73 – 78 , 82 – 84 , 86 – 88 ] explored coping strategies and positive action for the purposes of preventing or treating moral distress or injury. Both adaptive and maladaptive coping strategies were discussed, as well as effective and ineffective solutions.…”

Unpacking complexity in addressing the contribution of trauma to women’s ill health: a qualitative study of perspectives from general practice

“…This could erode the practitioner's efforts to deliver trauma informed care, with potential consequences for both patients and clinicians. Such structural constraints in a climate of overwork are powerful sources of moral distress and burnout in studies of nurses, midwives and doctors 20,21,22,23 .…”