Alienation in the Medical Profession: Physician Burnout and Moral Distress


Alienation in the Medical Profession: Physician Burnout and Moral Distress

Speaker: Prof. Elizabeth Dzeng (MD, PhD), University of California, San Francisco (UCSF).

Commentary: Dr Una St. Ledger, Queen’s University Belfast.

1800, Wednesday the 18th of January, 2017. 

Venue: JD seminar room 1 (MST/02/002) The School of Law, QUB.

Free to Attend. All Welcome.
As space is limited, registration is encouraged. Please email us at:

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Alienation in the Medical Profession (Prof Dzeng): Through interviews with 58 doctors in the US and UK, my doctoral research focused on the influence of institutional cultures and policies on doctors’ ethical beliefs and communication practices surrounding end-of-life decisions. I found that a great deal of American trainees felt ethically compromised and obligated to provide therapies that they perceived to be futile, leading to significant moral distress and possible burnout, declines in empathy, and cynicism.

Moral distress regarding end-of-life decisions did not seem to occur in UK junior doctors, likely because the UK, in contrast to the US, does not allow patients to demand ineffective treatments. However, distress occurred in UK junior doctors in other ways, related to stresses in the workforce and NHS highlighted by the recent junior doctor protests. In both countries, junior doctors are experiencing alienating forces that jeopardise their own well-being and ability to provide compassionate, empathetic care to patients.

American trainee physicians described to me a feeling that “nothing you do matters” and that they are “cogs in a wheel”. UK junior doctors described similar feelings of lack of control and bureaucratic decisions designed to increase efficiency at the expense of the patient and provider experience. The loss of the idealism that brought them into medicine results in alienation and in a feeling of meaninglessness in one’s work. The medical burnout literature focuses extensively on stress and overwork, but I believe that alienation and loss of meaning in one’s work is an underappreciated contributor to burnout.

Applying Marx’s theories of alienation to the medical profession provides theoretical insight into the underlying existential sources of burnout and declines in empathy. These feelings of powerlessness and suffering, along with cognitive coping mechanisms of detachment and dehumanization, causes declines in empathy and compassion during medical training. Moral distress can have a lasting impact on individual physicians and the culture of medicine as a whole. Individual acts of alienation, detachment and empathy loss further aggregate to reproduce a culture of dispassionate care and stoicism in the medical profession. A greater understanding of the underlying sources and mechanisms of discontent in the medical profession provide new avenues for interventions to improve the welfare and well-being of healthcare professionals.

All Welcome.