The resilient phenotype: Physicians who thrive despite adversity.

, , and are terms used to encapsulate the difficulties that arise when the relationship that individuals have with their work goes awry., Burnout, in particular, exquisitely captures the feeling of having had fizzled out. What started as a purposeful and fulfilling profession ends in a disappointing way. Among clinicians, the incidence of moral distress, moral injury, and burnout exceeds 50%., Moral distress, moral injury, and burnout—collectively termed
, —stem from a self‐evident reality: grief. Clinicians suffer, and as a consequence, so do patients. Among clinicians, the angst is moral—it is the distress that arises in response to an adversity that challenges our integrity. is the emotion experienced by an individual when the appropriate course of action is evident, but a series of obstacles such as scarcity of time, limited resources, lack of seniority, an organization's power structure, institutional policies, red tape, or legal considerations make it difficult to pursue the right course of action., , Moral distress tends to be situational, and as such it can be a collective emotion. In healthcare, moral distress arises from having to remain silent in the face of rude behavior, from witnessing wasteful use of medical resources, when doing things and not , and from lack of autonomy. goes a critical step further. It is the enduring psychological, spiritual, behavioral, social, and emotional harm inflicted on an individual's conscience when that person perpetrates, fails to prevent, or witnesses acts that conflict with their values or beliefs., Because moral injury stems from an affront to an individual's integrity, it can leave those who endure it feeling victimized, betrayed, wounded, guilty, and ashamed., If moral distress is situational and possibly collective, moral injury is individual and transcendent.