Beyond Burnout: Why a Group of Physicians Says ‘Heartache’ Names What Medicine Is Really Suffering

A team of physicians and scholars led by researchers at Duke University Divinity School and Duke University School of Medicine argues that the two dominant words used to describe the suffering of doctors and other clinicians—burnout and moral injury—fail to capture what is actually happening to the people who practice medicine. In a narrative review published in the Journal of General Internal Medicine, J. Brewer Eberly Jr. and colleagues, including Farr Curlin, Warren Kinghorn, and Brett McCarty, propose a different term: heartache. Their argument is not merely semantic. The word a profession chooses for its pain, they contend, determines the solutions it will pursue, and the solutions currently on offer are failing because the diagnosis itself is incomplete.

The term burnout entered the vocabulary from the world of industry and occupational psychology, popularized in the 1970s to describe workers whose emotional reserves had been depleted by demanding jobs. Its conceptual logic, the authors note, places the burden of recovery on the individual: if you are burnt out, you must cultivate resilience, practice mindfulness, take better care of yourself, and restore your own depleted reserves. Hospital wellness programs, resilience training modules, and app-based meditation subscriptions are the institutional descendants of this framing. Critics have long observed that such interventions treat a structural problem as a personal deficiency, effectively asking clinicians to adapt to conditions that may themselves be the pathology.

Moral injury, by contrast, was borrowed from the world of war. Originally developed to describe the psychological wound suffered by soldiers who were forced to participate in, or witness, events that transgressed their deepest moral commitments, the term migrated into medicine during the COVID-19 pandemic. Clinicians described being forced by staffing shortages, productivity targets, and insurance constraints to deliver care they believed was inadequate or even harmful. The moral injury framing, the authors acknowledge, has one clear advantage over burnout: it points the finger at systems rather than individuals, and it has energized calls for organizational reform, better staffing ratios, and reduced administrative burden. Yet even moral injury, they argue, tells only part of the story.

What both terms miss, according to the review, is love. Clinicians do not grieve their working conditions the way an assembly-line worker might; they grieve because they entered medicine out of a commitment to healing, to being present with suffering people, and to a vocation that once felt meaningful. The pain they experience when that vocation is frustrated is closer to the ache of a strained friendship or a lost love than to the exhaustion of an overworked laborer or the wound of a soldier. Heartache, the authors propose, comes from the world of love, and it names a sense of loss, lament, and enduring devotion to a beloved profession that burnout and moral injury cannot articulate. A heartbroken person does not simply need rest or a reformed workplace; they need communities that can hold grief, sustain hope, and imagine creative renewal.

The philosophical architecture of the argument draws on an unexpected source: the later work of Ludwig Wittgenstein. Rather than offering a strict definition of heartache, the authors employ Wittgenstein’s concept of family resemblance, the idea that certain phenomena are connected not by a single shared essence but by a network of overlapping similarities. They apply the same method to the reform projects they survey, identifying recurring features—hospitality, a capacity for teaching new ways of speaking and seeing, and deep wells of ethical, spiritual, and practical resources—rather than a rigid template. This approach allows diverse local experiments to be recognized as kin without forcing them into a standardized program, a deliberate contrast with the top-down wellness initiatives the authors criticize.

The review catalogs concrete examples of such communities across academic medical training programs and hospital systems. At Duke Divinity School, the Theology, Medicine, and Culture Initiative brings clinicians into sustained theological study and communal reflection on the ends of medicine. At Loyola University Chicago’s Stritch School of Medicine, the Physician’s Vocation Program invites students to examine medicine as a calling rather than merely a career. At Columbia University, Lydia Dugdale leads a Character Cooperative that uses shared meals—explicitly modeled on the communal feast depicted in the film Babette’s Feast—to form medical students in habits of attention and gratitude. At Wake Forest University School of Medicine, physician assistant educator Ethan Stonerook hosts dinners and a project called Planting Sequoias, which encourages trainees to invest in slow, long-horizon growth rather than the metrics of immediate productivity.

Surgical training, often considered the most punishing corner of medical education, features prominently as well. Ryan Antiel and Eberly lead a project called The Good Surgeon, which reframes surgical formation around accompaniment and proximity to patients rather than technical output alone. Related scholarship published in the Hastings Center Report argued for an ethic of accompaniment in surgical care, drawing on the legacy of the physician-anthropologist Paul Farmer, whose insistence on standing with the poor exemplified the kind of fidelity the heartache framework celebrates. Elsewhere, surgical residents have explored practices such as Sabbath-keeping as a form of resistance to a culture of ceaseless work, cultivating attention as a spiritual and clinical discipline rather than another productivity hack.

The authors are candid about the structural forces their proposal must contend with. They situate the present malaise within a longer history, noting that the Flexner Report of 1910, while standardizing medical education, also devastated training opportunities for Black physicians and embedded a reductionist, factory-model logic in American medical schools. They cite contemporary pressures ranging from the erosion of public trust in physicians documented in large pandemic-era surveys, to the financial toxicity experienced by patients, to the disorienting arrival of artificial intelligence in clinical decision-making, which studies suggest can shift patients’ trust depending on whether the machine agrees with the doctor. Against this backdrop, the heartache framework does not promise policy fixes; instead it insists that local communities of virtue and friendship are the places where the healer’s pain is most deeply felt and from which the most creative responses can best emerge.

The intellectual lineage of the argument is wide. The authors draw on the farmer-philosopher Wendell Berry’s essay Health Is Membership, which argues that health is inseparable from belonging to a community; on Nicholas Wolterstorff’s Lament for a Son, a meditation on grief that legitimizes lament as a form of love; on Aristotle’s account of friendship in the Nicomachean Ethics; and on the activist Dorothy Day’s conviction that community, however difficult, is the only setting in which love becomes practical. They also invoke the political anthropologist James C. Scott’s critique of state schemes that fail because they ignore local knowledge, using it to warn against national wellness mandates imposed from above. The physician’s calling, in this account, is sustained not by resilience training but by fidelity to trust—a virtue articulated decades ago by the ethicists Edmund Pellegrino and David Thomasma.

Whether the heartache framework can scale remains an open question, and the authors’ own disclosure of competing interests—several lead the very programs they describe—signals that this is a movement advocating for its own model rather than a detached evaluation. Still, the review arrives at a moment when physician burnout has reached what major outlets have called distressing levels, when loneliness among trainees is being studied as a clinical-ethical problem in its own right, and when commentators in the New England Journal of Medicine are asking whether medicine can reclaim agency, belief, and joy. By relocating the problem from the vocabulary of industry and war to the vocabulary of love, the Duke-led team offers clinicians something the standard wellness discourse cannot: permission to grieve, an account of why the grief is honorable, and a map of communities where that grief can be transformed into renewal. The rough ground, they suggest, is exactly where reform must begin.

Subject of Research: Reframing clinician distress as heartache rather than burnout or moral injury, with community-based models of medical formation

Article Title: The Healer’s Heartache: Reforming Medicine from the Rough Ground

Article References: Eberly, J. B., Jr., Curlin, F., Kinghorn, W., Frush, B. W., Antiel, R. M., Dugdale, L. S., Hardt, J., Kornu, K., Michel, A., Moyse, A., Nussbaum, A. M., Pickell, T., Stonerook, E., & McCarty, B. (2026). The Healer’s Heartache: Reforming Medicine from the Rough Ground. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10827-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10827-3

Keywords: heartache, burnout, moral injury, physician wellbeing, medical education, medical humanities, virtue ethics, friendship, clinical training, Duke University, Journal of General Internal Medicine, moral formation