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Physician Work Environment and Well-Being
April 8, 2019

Physicians’ Goodness and Guilt—Emotional Challenges of Practicing Medicine

Author Affiliations
  • 1Independent Private Practice, Philadelphia, Pennsylvania
  • 2Department of Anthropology, University of Pennsylvania, Philadelphia
  • 3Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Psychoanalytic Center of Philadelphia, Philadelphia, Pennsylvania
JAMA Intern Med. 2019;179(5):607-608. doi:10.1001/jamainternmed.2019.0428

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.

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    3 Comments for this article
    The Role of Guilt in Choosing Medicine is Questionable
    Edward Volpintesta, MD | Bethel Medical Group
    It’s hard for me to believe that guilt drove me into medicine. Everyone feels guilty about something—isn’t it part of the human condition?
    How about other more reasonable forces like wanting the prestige, or the financial security, or carrying on a family tradition, or simply being encouraged by one’s parents?
    Guilty pleasures
    Misha Denham, D.O. | Endocrine Solutions of S. FL.
    I appreciate this article and believe it is pulling the conversation about physician suicide and burnout full circle. There must be certain personality traits that drive a majority of us (physicians and surgeons) into an increasingly thankless job. Clearly self-flagellation for being a "bad" boy or girl makes sense for only a few personalities, while others may simply savor in the negative attention received. If there is a guilty personality type attracted to medicine we should be able to acknowledge it, make new medical school applicants' vulnerabilities more salient, and groom opportunities for the guilt to be recognized and released. This may dampen the current trend of "burnout" in our current medical world as we know it, and I will be more vigilant to internalize my own potential sources of guilt and expose the irrational patterns that lead to my rational path.
    Has Medicine Become Too Complicated to Protect Physicians' Goodness and Save Them From Guilt?
    Edward Volpintesta, MD | Bethel Medical Group
    Has the practice of medicine become too complicated? Is there simply too much research and too much to know? Have physicians as a result become too vulnerable to error and liability?
    Do patients expect perfection from doctors?
    Does the medical liability system exploit physicians?
    If so, then regardless of how good or bad or indifferent physicians’ or medical school applicants’ personality traits may be, the emotional challenges of practicing medicine will surely increase with time.
    Is there really an answer?