Calling BS on "burnout" & getting real on ethical, client-centered Dietetic practice

A few months ago now, I heard a new phrase to describe an experience and observation which has been eating at me for years. I couldn’t put my finger on it. Over time, I noticed the disillusionment, the frustration, the feelings of isolation (and, duh, noticed it in myself) and asked “why are Dietitians feeling this way?”, “why, when this is a client-centered profession, does it so often feeling anything BUT client-centered?” and “why are my colleagues – smart, courageous, committed people – leaving the profession early in their careers, and at alarming rates?” I have been at the sticky end of these experiences myself, my body telling me everything my mind could not. I named my experience(s) as “burnout,” borrowing the word from common lexicon, and feeling like it aptly described what was going on both in my body and mind. Problematically, I also – silently, quietly – blamed myself. What’s going on? Why couldn’t I cope when it seemed as though everyone else was doing just fine? More meditation? More self care? More fresh air? Perhaps. But that’s not the end of the story, or as it turns out, not even close to the start of it.

Gulp.

As it turns out, we’ve got this all wrong. Kind of like so many other things in weight-centric healthcare. It’s not good enough to say “Woopsie! Soz!” – we have to raise our voices to make it right and advocate for ourselves in a system which is not designed for clinician longevity or, ironically, client-centered care.

What I wasn’t aware of is that what I used to name it as “burnout” or the slightly more heart-centered “compassion fatigue” is a form of victim blaming, holding the individual responsible not only the for the experience but also for the solution.

And thanks to a good friend and colleague who introduced me to a new way of seeing these experiences, I’ve found a phrase for it. Moral injury, defined as “the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct….”

Originally coined by Dr Wendy Dean & Dr Simon Talbot as a way to describe the experiences of war, we can draw upon these ideas as helpful ways to relocate our experiences and understand them as dynamic forces from both outside and within us, and have impacts in ways which make client-centered practice very difficult, if not impossible.

PAUSE. WATCH THIS CLIP.

What does this mean for Dietitians?

Essentially, moral injury in the context of Dietetic practice as I see it are any experiences we have which interrupt our ability to engage in values-driven, ethically-based, client-centered practice. Ways in which the demands on us to meet the expectations of others (and ourselves) chip away at the vision we had or have of ourselves as “helpers.” In other words, the reasons we wanted to be Dietitians in the first place.

We care. And we’re often not able to care in a way that centres the needs of our clients. Not only that, but the very ethics and values which have brought us into this profession (ie doing what’s right, or best) are being sidelined in favour of doing what is expected of us. And they are not necessarily in alignment.

As it turns out, it’s not disillusionment, it’s moral injury.  And it’s not our fault.

How can moral injury show up for Dietitians?

We get a referral for “weight loss” for someone for whom this would not only be unhelpful for, but also potentially harmful. And, unless we “perform” what feels to be expected of us, our referral streams and income are in jeopardy.

It’s when highly experienced Dietitians are pushed to the side in singe-therapist eating disorder treatment models and our “role” is taken by another professional who has never studied nutrition. Then we are expected to do the work to “prove” our role, our importance, our value.

When we are given two EPC sessions to see someone with a highly complex health condition. How effective can we possibly be?

When client-centered practice is being held up as “do what the client wants you to do”, effectively destabilising our role & holding us hostage in the system which expects us to “perform” and “deliver” but at the expense of both our own wellbeing, and our clients.

It’s important that we understand - and have every right to be annoyed about - that we are working in systems that are not designed with our career longevity in mind. Increasingly here in Australia we are moving towards a more “Americanised” model of healthcare where patients are numbers and our time is not counted in compassionate care, but in minutes. Workplaces are becoming dysfunctional & boundaries are disregarded. It’s not just us – arguably, all health practitioners are suffering and possibly worst of all, doctors many of whose working conditions are absolutely ridiculous.

By now, you’re probably thinking “ok whinger, so you’re pointing out what’s wrong, what’s the “treatment?”

I pose the “treatment” is firmly rooted in prevention. It’s definitely not about doing better by doing more, a pervasive and harmful narrative within our profession. It’s about doing different. Doing smarter. Using our values, ethics & healthcare evidence to shift priorities and the existing narratives about the role of the Dietitian.

OK. Yes, self care (whatever that looks like to you, even the boring bits) is important. Yes, opportunities for supportive practice-based and personal self reflection (otherwise known as “supervision”) is important. Connecting with communities of colleagues is essential. But again, that’s taking ALL the responsibility for a system that is built to train us, and spit us out into models of “care” that are……not particularly caring. To us, or to our clients, patients and communities.

Within Dietetics, I believe one way forward is to raise our voices about Health At Every Size ® and the practice principles, the Non Diet Approach, as evidence-based, values-driven, ethical & truly client-centered paradigm. And continue to push for it to be deeply embedded into Dietetic training and ongoing training training & support. Exploring the topics of stigma, trauma, privilege & offering consistent opportunities for self reflection are, I believe, powerful ways we can inoculate students & graduates against moral injury.

Learn more about HAES, Non Diet Approaches & Weight Science. Attend training, sign up for online learning (here and here at EDRDPro), engage in regular supervision. When we feel more grounded, we can communicate more clearly and strongly.

The “problem” is in the system, not within us. We can’t lose any more good people. There is no “burnout” without external forces which grind us into the ground. We can only do meaningful work in this world when we stay engaged - with ourselves, our clients and our communities. When we call BS on “burnout” & relocate the source of this anguish, I argue we can substantially improve client care & ongoing commitment to ethical Dietetic practice. Raise your voice to support each other, and every student coming through the system right now. We all deserve better.