Demoralization in health professional practice: development, amelioration, and implications for continuing education.

Demoralization is a feeling state of dejection, hopelessness, and a sense of personal "incompetence" that may be tied to a loss of or threat to one's own goals or values. It has an existential dimension when beliefs and values about oneself are disconfirmed. Numerous sources describe high rates of dissatisfaction and burnout in physicians and other health professionals. This article reviews historical and empirical findings that describe the professional and personal value orientations of physicians and other health professionals. It reviews empirical and theoretical findings to consider the implications of conflict between these values and negatively perceived ethical and values orientations of health care organizations and commercial health care entities. Conflicts between personal and professional values of health professionals and larger health care related organizations and commercial entities with which they are associated may contribute to the development of demoralization and burnout. Physicians and other health professionals frequently experience values related conflicts with larger social, organizational or bureaucratic systems. These conflicts place health professionals at risk for demoralization and burnout. "Remoralization," or renewal of morale, depends on the reestablishment of the potential for fulfillment of one's values in the work environment. This depends on organizational, group, and personal efforts. Continuing education and continuing professional development programs should have a programmatic focus on the importance of a values orientation in health care and support program development aimed at recognizing, addressing, and reducing demoralization and its potential for negative health care consequences for health professionals and patients.