Letting Go of Guilt: What Every Physician Needs to Hear After a Difficult Outcome

As physicians, we feel great responsibility for our patients. We are in charge of their well-being. We are here to make their lives better, physically and emotionally.

When things do not go as planned, or when a patient’s outcome is not as expected, in a negative way, it is easy to think that you did something wrong. That reflex idea starts to plant deeper in your mind, gradually convincing you that you most likely did something wrong, otherwise the outcome would have been different. You start to feel guilty. Even when you have followed the guidelines, the standard protocols, and you are pretty sure you did not do anything outrageous, the feeling of guilt is haunting you, convincing you that you must have done wrong despite there is no evidence of it.

That guilt makes you feel responsible for the patient outcome. You keep going back and forth, thinking what you could have done differently to change the outcome. You are distracted, you have a hard time to focus, because your mind is replaying the scenario of that particular incident.

When you are feeling guilty about a patient’s situation, be it an adverse reaction, a progression of disease or even unexpected death, it is important to realize that you are feeling guilty. Identify what exactly you are feeling guilty about. Be as specific as possible. For example, if you are feeling guilty because you “should have done something different” – that is somewhat vague. An example of being specific is: “The patient developed these unexpected and unusual adverse effects from this treatment regimen”.

Once you identify the thought behind you feeling guilty, allow yourself to feel. Experience that feeling of guilt in your body. Do not resist it, even though it does not feel comfortable. Let yourself experience the whole spectrum of feelings and have the awareness of what ideas or thoughts are behind those feelings.

Now that you have identified the specific situation, the thought that is causing you to feel guilty, the next question to ask yourself is if you could have changed the outcome – that is, is that something in your control? It is common to feel guilty and immense responsibility for a bad outcome that you did not do anything to cause it. Somehow you believe you caused it. It is, therefore, important to distinguish between what you can control and what you cannot control. For things you cannot control, no matter what badly you want to, there is nothing you can do about them. You can, however, manage how you are going to react to those things. You are not responsible for things you cannot control.

Have compassion for yourself. Talk to yourself kindly. Imagine if something like this, something that caused the guilty feeling happened to a close friend. How would you talk to that person? I imagine it would be a conversation filled with kindness and love. You would probably do your best to be encouraging and uplifting. You would do it without judgment. You would do your best to help your friend feel better. I invite you to do the same for yourself.

Feeling guilty, even though you did nothing wrong, can stop you in the middle of the tracks. It can disrupt your focus and scatter your concentration. It can let you dwell in a play-back mode of that incident. It affects your well-being and patient care. Identify and be specific about what is causing you to feel guilty. Allow yourself to feel that not-so-pleasant guilt. Is that something you can control or not? Could you have changed the outcome? Be compassionate, be loving and kind to yourself, without judgment. Be uplifting and encouraging. If you are stuck, if you do not know how to get out of the guilty mode, talk to someone about it and ask for help.