The Healer's Heartache: Reforming Medicine from the Rough Ground

Current and future clinicians are experiencing a malaise that is at once deeply felt yet difficult to articulate. While "burnout" and "moral injury" have come to dominate many accounts, these terms do not fully capture the experience of clinicians who struggle to name a sense of loss, lament, and love for a beloved profession. Therefore, we propose "heartache" as a more fitting description. While burnout comes from the world of industry and moral injury from the world of war, heartache comes from the world of love. Burnout depends on individuals to cultivate resilience, and moral injury encourages systems-level change. By contrast, heartache moves the healer toward local communities of virtue and friendship where the healer's heartache is most deeply felt and from which creative responses can best emerge. We name several examples of such communities at different academic medical training programs and hospital systems, exploring the "family resemblances" shared among these projects. In these examples, we show how such efforts engage healers not merely as burnt-out workers or morally injured agents, but as friends-through an emphasis on hospitality, a capacity for teaching new ways of speaking and seeing, and deep wells of ethical, spiritual, and practical resources which nourish the heart.