The Hidden Weight of Physician Guilt

Most physicians lead with a servant heart. They are here to help patients. Sometimes that dedication to serve gets to the point that when they are asked to do more, there is an intense feeling of guilt if they say no – even though that task is beyond the scope of their work.

As physicians, we are used to taking care of others – everyone else but ourselves. Sometimes we feel guilty because we want to take care of ourselves. Your department head asked you to take over an additional role, without extra compensation. You want to say no, but you feel guilty. You think that by saying no, you are perceived as not playing with the team – although you are exhausted and mentally drained.

Take another example. You are treating a patient who has a complicated medical history. He has advanced cancer. You are doing your best to follow the guidelines to offer the standard of care, modify as you go because, as you know, most patients do not follow the textbook with their disease processes. The patient is having different adverse effects, not responding to the different lines of treatments you offered. He decides to leave your practice and establish care somewhere else. You feel immense guilt because you thought you could have done better, you should have done better. The patient was supposed to have a different outcome.

It is important to recognize that you are experiencing guilt. I am not talking about when you did something wrong. In medicine, especially for physicians, guilt may come on when you think you did something wrong. That guilt may become the voice in your head that is telling you that you should have done things differently, or even generalizing to you are not good enough. You blame yourself for things you are not responsible for.

As you are recognizing the feeling of guilt, ask yourself what the main reason behind it is. In other words, what are you thinking that is causing you to feel guilty? Remember, it is not the situation or the action. It is how you perceive them. Once you pinpoint the reason, acknowledge it. Accept it – accept the fact that you are thinking this which causes you to feel guilty.

What does the guilty feeling do to you? Besides causing you to feel unpleasant, uncomfortable, you may also experience rumination. Guilt may stop you from moving forward, both physically and emotionally. Guilt begets guilt, along with many more negative emotions. You blame yourself for things which are not even of your doing. You start to question your purpose. You start to question your worth.

This is when it is important to pause. Take a step back and look at your situation. Ask yourself if this is something you can control or not. There are two categories of things in life – things you can control, and things you cannot control no matter what you do. Are you feeling guilty because of things you cannot control? Give yourself lots of love and kindness. Talk to yourself in a tender loving way. Love who you are. You are doing your best given the circumstances. You cannot predict the future of the outcome of many things, and that is okay.

Know that you are worthy. You are born worthy – worthy to be in this world, worthy to be a physician, worthy to make a difference in someone’s life. An undesired outcome does not change your worth.

What can you learn from your experience? Examine the situation. Notice how you handle it and how you feel. What went well? What could have been different? What will you do differently next time?

If you are still feeling stuck in feeling guilty and cannot figure out how to get out of it, talk to someone. Ask for help – from a colleague, mentor, therapist or a coach. Sometimes, by talking about it, helps you look at things differently and more clearly.

Guilt is a strong sense of wrongful doing, and it can come up even when you did nothing wrong. As physicians, we want to help everyone. We want to do everything. Acknowledge that we are human beings too and we are not perfect. It is okay to do your best within your ability and not help “everyone”. When you feel guilty, recognize it, acknowledge it. Find out what you are thinking that is causing you to feel that way. Accept it. Then rethink the situation – is it something you can control or not? Are you blaming yourself for things you cannot control? Always know your worth, as you are worthy no matter what. Be loving and kind to yourself, just as you would to others. Our lives are full of experiences to learn and grow from. Ask for help if you feel stuck.