Some Doctors Struggle With Guilt Amid COVID-19 Crisis

About 20 or so women were gathered for a late afternoon video conference. Some had glasses of wine, or cups of coffee. You could see pets in a few frames. It was March 26, when COVID-19 cases were beginning to ramp up in Indiana.

One of the women, Dr. Theresa Rohr-Kirchgraber, posed a question: Was anyone else feeling guilty? 

“I kind of figured that if I was feeling that way, I'm sure a couple of others were,” Rohr-Kirchgraber recalls. “Maybe giving voice to it would help me address it in some way and help to take away a little bit of the pain.” 

The Zoom session was a wellness meeting for women faculty at the Indiana University School of Medicine. Since the start of the pandemic, the group has gathered virtually to check in and provide emotional support.

Rohr-Kirchgraber's feelings of guilt resonated with another woman in the meeting, Dr. Cindy Brown. 

“I was really, for several weeks, having a lot of trouble sleeping,” Brown says.

Doctors have high rates of burnout, depression and suicide. But there’s a less-understood emotion doctors also struggle with: guilt.

Brown treats patients with cystic fibrosis, a genetic disorder that affects the lungs. Rohr-Kirchgraber works with adolescents with eating disorders. Both provide virtual care, but neither work with COVID-19 patients on what’s being called the front lines of the pandemic.

And that makes them feel guilty. Rohr-Kirchgraber knows her work is important, but she sometimes feels like a fraud.

“You're getting a lot of comments from friends and neighbors, ‘Oh, good for you, take care, front lines,’” she says. “And I have to kind of go, ‘Uh, thanks.’”

Brown has had similar experiences. After a day at the office seeing patients virtually, she stopped for gas, still wearing her scrubs. Someone thanked her for being a hero. 

“And [I'm] not feeling like the hero,” she says.

Guilt is a common feeling among physicians, but it’s not well studied, says Dr. Lawrence Blum, a Philadelphia-based psychiatrist and psychoanalyst who has written about doctors' guilt and treated them for years. 

“What they're describing is, I think, not unusual for doctors,” Blum says. “The felt need to do more than you're already doing, or that what you're doing somehow isn't enough. It's almost like a pre-existing condition that now is exacerbated by the current situation with the COVID-19 pandemic.” 

In his practice, Blum found guilt causes doctors to hold themselves to unrealistic standards they can’t meet while treating COVID-19, a disease they’ve never experienced.

“They're used to saving people. And most patients, there's a lot of stuff they can do for them,” Blum says. “Now, many of them are in a circumstance where they're inundated with really sick patients, and there's sometimes nothing they can do for them.”

The guilt is more complex for doctors who don’t see COVID-19 patients. Dr. Katherine Gold, who works in family medicine and researches physician mental health at the University of Michigan, compares it to the survivor’s guilt someone might feel after a natural disaster.

“One of the most important components is that you feel very connected to the other people,” she says. “So maybe there's a tornado that hits in your neighborhood … so you think, ‘Oh, it could have been me.’” 

Gold says physicians feel connected that way; they share values and have similar training. She has heard her own colleagues who don’t treat COVID-19 patients echo feelings of helplessness and guilt for not being on the front lines. And she has felt it herself.

“I got really sick when COVID hit, and I felt bad that I wasn't there to go see patients. You feel a little less legitimate as a doctor when you're not out there,” Gold says. “You kind of want to protect people who you see as similar, and you can't do that.” 

That was Brown’s experience. A friend directs an intensive care unit in New York City, where between mid-March and late April, hundreds of people were dying of COVID-19 every day. 

Brown wanted to know how he was doing, but was nervous to email him. She knew he was busy. Her friend wrote back and said he was tired, but healthy. And he asked Brown how she was doing. 

“I actually told him I do feel guilty for not being and doing more,” she says. “And he was the one who told me, ‘Please don't feel guilty. I'm happy that you're not having to be part of this.’” 

Brown says that alleviated some of her guilt. And the wellness meetings with IU’s med school faculty created a safe space for the women to share their feelings.

Rohr-Kirchgraber says women in science and medicine might feel more guilty than their male colleagues. "In general, women have a tendency to just put more on their plate and then feel less satisfied because it's harder to do everything super well.”

She, Brown and a group of the Indiana doctors have also discussed their feelings of guilt in an essay published on the physician blog KevinMD.

"Some folks said how grateful they were that we put this out there, because this is what they've been thinking and they thought they were the only ones,” Rohr-Kirchgraber says. “When you give voice to something, you help to decrease that power that it has over you.” 

The doctors say they have to remember their work is still meaningful for their patients.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Contact reporter Lauren Bavis at lbavis@wfyi.org or follow her on Twitter @lauren_bavis