Do Surgeons Experience Moral Dissonance When There Is Misalignment Between Evidence and Action? A Survey and...

Area of Science:

• Orthopedic Surgery
• Medical Ethics
• Health Professions Education

Background:

• Moral dissonance, a psychological discomfort, arises from conflicts between moral values and actions.
• In surgery, this can stem from perceived harm versus benefit or external pressures to operate without clear evidence.
• Understanding moral dissonance is key to enhancing clinician joy and well-being in practice.

Purpose of the Study:

• To identify factors associated with pressure to act against best evidence in musculoskeletal surgery.
• To determine factors influencing the likelihood of offering surgery in discretionary cases.

Main Methods:

• A scenario-based online survey experiment was conducted with 114 musculoskeletal surgeons.
• Participants rated pressure to act contrary to evidence and likelihood of offering surgery across 12 scenarios with randomized patient and practice factors.
• Multilevel mixed-effects linear regression models analyzed associations, controlling for confounding variables.

Main Results:

• Greater pressure to act contrary to best evidence was linked to patient despair and strong preferences.
• Surgeon income independent of revenue and no financial benefit to surgery reduced this pressure.
• Marketing concerns were the sole factor associated with an increased likelihood of offering surgery.

Conclusions:

• Patient factors (distress, preferences) and surgeon financial incentives significantly correlate with moral dissonance in discretionary fracture surgery.
• Proactive strategies are needed by surgeons, practices, and associations to mitigate moral dissonance and support job satisfaction.