Moral Distress for Docs Providing Emergency-Only Hemodialysis

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Docs describe burnout and emotional exhaustion; moral distress at seeing suffering and injustice.
Docs describe burnout and emotional exhaustion; moral distress at seeing suffering and injustice.

(HealthDay News) -- Clinicians who provide emergency-only hemodialysis (EOHD) to undocumented immigrants experience moral distress and professional burnout, according to a study published online in the Annals of Internal Medicine.

Noting that undocumented immigrants receiving EOHD experience psychosocial distress and much higher mortality than patients receiving regularly scheduled hemodialysis, Lilia Cervantes, MD, from Denver Health and the University of Colorado, and colleagues examined clinicians' experiences providing EOHD. Fifty interdisciplinary clinicians experienced in providing EOHD were interviewed; the interviews were analyzed using thematic analysis.

The researchers identified 4 themes and 13 subthemes. The themes were drivers of professional burnout, including emotional exhaustion from witnessing unnecessary suffering and high mortality, jeopardizing patient trust, detachment from patients, perceived lack of control over EOHD criteria, and physical exhaustion; moral distress from propagating injustice, including altered care based on non-medical factors, focusing on volume at the expense of quality, and needing to play the system; confusing and perverse financial incentives, including wasting resources, confusing financial incentives, and concerns about sustainability; and inspiration toward advocacy, which included deriving inspiration from patients and strengthened altruism.

"The burden of EOHD on clinicians should inform discussions of systemic approaches to support provision of adequate care based on medical need," the authors write.

References

Cervantes L, Richardson S, Raghavan R, et al. Clinicians' Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants: A Qualitative Study. Ann Intern Med. 2018. DOI: 10.7326/M18-0400

Sehgal AR. Dialysis Without Borders. Ann Intern Med. 2018. DOI: 10.7326/M18-1267.

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