Physicians’ Goodness and Guilt—Emotional Challenges of Practicing Medicine

Abstract

Physicians want to do good. Physicians also have high rates of burnout, depression, and suicide. These 2 facts are closely associated. As a psychiatrist and psychoanalyst who has treated many physicians, I have repeatedly observed that the need to do good derives in part from hidden guilt and has substantial effects on how physicians experience themselves and their work. Among the many motives for wanting to be a physician, the one that applicants to medical school most commonly mention is wanting to do good. Medical literature on physician burnout, depression, and suicide, however, has focused on structural and cultural problems of medical practice and has paid little attention to physicians' emotional lives. 1 The hidden guilt and need to do good can facilitate the practice of medicine, but they also make an important, and perhaps unrecognized, contribution to physicians' vulnerability to burnout, depression, and suicide.Dictionaries define the emotion of guilt as "a feeling of having committed wrong or failed in an obligation" 2 or "a feeling of responsibility or remorse for some offense, crime, wrong, etc, whether real or imagined." 3 In fact, people commonly feel guilty when they have actually done nothing wrong. All sorts of experiences in childhood, such as deaths in the family, illnesses, traumas, abuse, divorce, and problematic relationships can saddle a person with an unrecognized burden of guilt. This guilt may be hidden for a

Professional Dissonance and Burnout in Primary Care

“…Second, this study reinforced the importance of professional dissonance as a key aspect of physician burnout and low professional fulfillment . Each of the contributing factors we identified, as well as many identified in other studies, such as meaning in work, may be better understood within the framework of professional dissonance, which helps explain how those factors lead to burnout.…”

Imposter Phenomenon in US Physicians Relative to the US Working Population

“…[11][12][13][14] In aggregate, these mindsets lead many physicians to engage in unhealthy levels of self-sacrifice manifested by excessive work hours, anxiety about missing something that would benefit their patients, and prioritizing work over personal health. 15,16 The concept of low self-valuation encompasses a harsh response to perceived personal shortcomings and perpetual deferral of self-care and personal needs to meet the needs of others. 17,18 Low levels of self-valuation appear to be an Achilles' heel for physicians.…”

Suicidal Ideation and Attitudes Regarding Help Seeking in US Physicians Relative to the US Working Population

“…[26][27][28] Physicians' deep-seated altruism and desire to do good also often lead to unrealistic expectations and a sense of guilt of "not doing enough." 29,30 These sentiments often lead physicians to sacrifice themselves (excessive work hours, constant worry that they may be missing something that would benefit their patients, and prioritizing work over personal health), leading to emotional distress and suffering. 30 Although physicians are empathetic and compassionate with others, they are frequently intolerant of their own imperfections and harshly critical of their own errors.…”

“…29,30 These sentiments often lead physicians to sacrifice themselves (excessive work hours, constant worry that they may be missing something that would benefit their patients, and prioritizing work over personal health), leading to emotional distress and suffering. 30 Although physicians are empathetic and compassionate with others, they are frequently intolerant of their own imperfections and harshly critical of their own errors. 29,31 The construct of low "self-valuation" is defined by this harsh internal response to perceived personal shortcomings and an associated propensity to defer self-care.…”