Health

The Moral Crisis of America’s Doctors

Published

2 years ago

June 15, 2023

Dean’s essay caught my eye, too, because I spent much of the previous few years reporting on moral injury, interviewing workers in menial occupations whose jobs were ethically compromising. I spoke to prison guards who patrolled the wards of violent penitentiaries, undocumented immigrants who toiled on the “kill floors” of industrial slaughterhouses and roustabouts who worked on offshore rigs in the fossil-fuel industry. Many of these workers were hesitant to talk or be identified, knowing how easily they could be replaced by someone else. Compared with them, physicians were privileged, earning six-figure salaries and doing prestigious jobs that spared them from the drudgery endured by so many other members of the labor force, including nurses and custodial workers in the health care industry. But in recent years, despite the esteem associated with their profession, many physicians have found themselves subjected to practices more commonly associated with manual laborers in auto plants and Amazon warehouses, like having their productivity tracked on an hourly basis and being pressured by management to work faster.

Because doctors are highly skilled professionals who are not so easy to replace, I assumed that they would not be as reluctant to discuss the distressing conditions at their jobs as the low-wage workers I’d interviewed. But the physicians I contacted were afraid to talk openly. “I have since reconsidered this and do not feel this is something I can do right now,” one doctor wrote to me. Another texted, “Will need to be anon.” Some sources I tried to reach had signed nondisclosure agreements that prohibited them from speaking to the media without permission. Others worried they could be disciplined or fired if they angered their employers, a concern that seems particularly well founded in the growing swath of the health care system that has been taken over by private-equity firms. In March 2020, an emergency-room doctor named Ming Lin was removed from the rotation at his hospital after airing concerns about its Covid-19 safety protocols. Lin worked at St. Joseph Medical Center, in Bellingham, Wash. — but his actual employer was TeamHealth, a company owned by the Blackstone Group.

E.R. doctors have found themselves at the forefront of these trends as more and more hospitals have outsourced the staffing in emergency departments in order to cut costs. A 2013 study by Robert McNamara, the chairman of the emergency-medicine department at Temple University in Philadelphia, found that 62 percent of emergency physicians in the United States could be fired without due process. Nearly 20 percent of the 389 E.R. doctors surveyed said they had been threatened for raising quality-of-care concerns, and pressured to make decisions based on financial considerations that could be detrimental to the people in their care, like being pushed to discharge Medicare and Medicaid patients or being encouraged to order more testing than necessary. In another study, more than 70 percent of emergency physicians agreed that the corporatization of their field has had a negative or strongly negative impact on the quality of care and on their own job satisfaction.

There are, of course, plenty of doctors who like what they do and feel no need to speak out. Clinicians in high-paying specialties like orthopedics and plastic surgery “are doing just fine, thank you,” one physician I know joked. But more and more doctors are coming to believe that the pandemic merely worsened the strain on a health care system that was already failing because it prioritizes profits over patient care. They are noticing how the emphasis on the bottom line routinely puts them in moral binds, and young doctors in particular are contemplating how to resist. Some are mulling whether the sacrifices — and compromises — are even worth it. “I think a lot of doctors are feeling like something is troubling them, something deep in their core that they committed themselves to,” Dean says. She notes that the term moral injury was originally coined by the psychiatrist Jonathan Shay to describe the wound that forms when a person’s sense of what is right is betrayed by leaders in high-stakes situations. “Not only are clinicians feeling betrayed by their leadership,” she says, “but when they allow these barriers to get in the way, they are part of the betrayal. They’re the instruments of betrayal.”

Not long ago, I spoke to an emergency physician, whom I’ll call A., about her experience. (She did not want her name used, explaining that she knew several doctors who had been fired for voicing concerns about unsatisfactory working conditions or patient-safety issues.) A soft-spoken woman with a gentle manner, A. referred to the emergency room as a “sacred space,” a place she loved working because of the profound impact she could have on patients’ lives, even those who weren’t going to pull through. During her training, a patient with a terminal condition somberly informed her that his daughter couldn’t make it to the hospital to be with him in his final hours. A. promised the patient that he wouldn’t die alone and then held his hand until he passed away. Interactions like that one would not be possible today, she told me, because of the new emphasis on speed, efficiency and relative value units (R.V.U.), a metric used to measure physician reimbursement that some feel rewards doctors for doing tests and procedures and discourages them from spending too much time on less remunerative functions, like listening and talking to patients. “It’s all about R.V.U.s and going faster,” she said of the ethos that permeated the practice where she’d been working. “Your door-to-doctor time, your room-to-doctor time, your time from initial evaluation to discharge.”

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Water for Weight Loss? How Much You Should Drink to Shed More Weight

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January 19, 2025

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Ivanka Trump stays fit with this self-defense practice: ‘Moving meditation’

Published

2 hours ago

January 19, 2025

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Ivanka Trump stays fit with this self-defense practice: ‘Moving meditation’

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Ivanka Trump, the daughter of incoming President Donald Trump, has been known to lead an active life.

As the mother of three kids and a lover of outdoor sports, the 43-year-old is always on the move, recently adding jiu-jitsu to her mix of physical activity.

In a recent appearance on The Skinny Confidential Him & Her podcast, Trump shared how her daughter, Arabella, expressed interest in learning self-defense when she was 11.

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“I’m just so in awe of [her],” Trump said about her daughter. “She came to me and said, ‘As a woman, I feel like I need to know how to defend myself, and I don’t have a confidence level yet that I can do that.’”

Ivanka Trump plays with her daughter, Arabella Rose Kushner, in the Rose Garden during a Congressional Picnic on the South Lawn of the White House in June 2017. (Alex Wong/Getty Images)

Trump responded, “At 11 … I was not thinking about how to physically defend myself, and I thought it was the coolest thing.”

After researching self-defense options, Trump enrolled Arabella, now 13, in jiu-jitsu (martial arts) classes with the Valente Brothers in Miami, Florida – and soon the whole family joined in.

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“[Arabella] started asking me to join – I joined,” she said. “Then my two sons wanted to do what their older sister was doing. Then my husband joined … It is good for everyone.”

“It’s almost like a moving meditation.”

Trump, who is now a blue belt in jiu-jitsu, described that she likes how the sport “meshes physical movement.”

“It’s almost like a moving meditation because the movements are so micro,” she said. “It’s like three-dimensional chess.”

“There’s like a real spiritualism to it … The grounding in sort of samurai tradition and culture and wisdom.”

During President Trump’s first term in the White House, Ivanka Trump noted that she had very little focus on fitness, only taking weekly runs with husband Jared Kushner and “chasing the kids around the house.”

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Trump shared that she was “never a gym person,” but always loved sports, which still holds true today.

She said she enjoys skiing, surfing and racquet sports like padel tennis (a hybrid of tennis and squash) and pickle ball, which she described as “fun and social.”

Ivanka Trump and Jared Kushner are seen out for a walk with their children on Dec. 10, 2022, in Miami, Florida. (MEGA/GC Images)

‘Elevating awareness’

On the podcast, Trump said she was drawn to jiu-jitsu because it combines physical fitness and philosophy.

It also focuses more on how to extract yourself from a dangerous situation before having to harm someone who’s a threat, she noted.

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“Having these skills makes you less likely to get into a fight, not more likely to,” Trump went on.

“Once you have the confidence that you can sort of move out of a situation, there’s a real focus on elevating awareness.”

Ivanka Trump waves as she arrives at Joint Base Andrews in Maryland for US President Donald Trump’s departure on Jan. 20, 2021. (ALEX EDELMAN/AFP via Getty Images)

In a previous interview with Fox News Digital, Rener Gracie, head instructor of jiu-jitsu at Gracie University in California, stressed that the only truly reliable skills are those that have been “mastered into muscle memory.”

This occurs through extensively practicing self-defense methods like Brazilian jiu-jitsu, which are “leverage-based and don’t rely on you having a physical advantage over the subject,” he noted.

“Having these skills makes you less likely to get into a fight, not more likely to.”

“And by that, I mean strength, speed, power and size — because in almost every case, the attacker is going to target someone who they feel is physically inferior to them.”

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Gracie, whose family created Brazilian jiu-jitsu and the UFC (Ultimate Fighting Championship), shared that jiu-jitsu is “highly sought after” because it only takes weeks or months for someone to “develop the core skills that could keep them safe in a violent physical encounter.”

‘Transformative’ strength training

In addition to mastering self-defense skills, Ivanka Trump recently revealed a shift in her fitness routine to include weightlifting and resistance training.

On Instagram, Trump posted a video displaying different exercises with various equipment in the gym, noting in the caption that she used to focus primarily on cardio, yoga and Pilates.

“Since moving to Miami, I have shifted my focus to weightlifting and resistance training, and it has been transformative in helping me build muscle and shift my body composition in ways I hadn’t imagined,” she wrote.

“I believe in a strength training approach built on foundational, time-tested and simple movements – squats, deadlifts, hinges, pushes and pulls. These are the cornerstones of my workout, emphasizing functional strength for life.”

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Trump added that prioritizing form is “essential” to ensure results before adding on weight.

“This ensures a safe and steady progression while maintaining the integrity of each movement,” she continued. “I incorporate mobility work within my sessions to enhance range of motion.”

“I believe in a strength training approach built on foundational, time-tested and simple movements – squats, deadlifts, hinges, pushes and pulls,” Ivanka Trump wrote in an October Instagram post. (Ivanka Trump/Instagram)

“Weightlifting has enhanced not just my strength but my overall athleticism and resilience,” she added.

Trump said she dedicates three to four days a week to strength training, including two solo sessions and two with a personal trainer.

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She also said that increasing her protein intake has also been “critical” to her progress.

“I now consume between 30 and 50 grams of protein a meal,” she said. “It works … I’ve never been stronger!”

Jared Kushner and Ivanka Trump are seen arriving at the beachside eatery on May 2, 2024, in Miami Beach, Florida. (MEGA/GC Images)

Trump also still enjoys weekly yoga sessions, spending time outdoors with her children and playing sports with friends, she said.

“I also incorporate a couple of short (10-minute), high-intensity interval training sessions (such as sprints) each week to keep my cardiovascular fitness sharp and dynamic,” she noted.

“This balanced approach has infused new energy into my fitness routine and yielded great results.”

Fox News Digital reached out to Ivanka Trump for comment.

Health

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January 18, 2025

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