The Many Faces of Guilt in Medicine

Let’s talk guilt. Many in medicine are high achievers, so it’s no surprise that residents often carry more than their share of it.

Mom guilt. Partner guilt. Friend guilt. Doctor guilt. Food guilt. Workout guilt. We feel it all.

But not all guilt is the same. Some of it is helpful and adaptive. And some of it... isn’t.

Where It Starts

One major root of resident guilt is maladaptive perfectionism, not the motivational kind, but the kind that’s unrealistic, exhausting, and quietly eroding.

In family medicine, that might mean striving to be the perfect physician: cradle to grave, inpatient, outpatient, prenatal care, procedures, rural and urban. While also trying to be the perfect friend, partner, parent, mentor, neighbor, and community advocate.

Most of us would never say, “I want to be perfect,” but our reaction when something is “less than” reveals the truth. We think something has gone wrong. We’re incredibly hard on ourselves.

The “Should” Trap

Perfectionism is closely tied to a common thought distortion: the “should” and “shouldn’t” mindset.

I should have checked the magnesium yesterday when the potassium wouldn’t budge.
I should have left work earlier.
I shouldn’t have forgotten that birthday.
I should call…

These thoughts pretend to be useful—motivating, even. But they’re not.

Turned inward, they fuel guilt, frustration, and anxiety, and lead us to make poor decisions. Turned outward, they create resentment and disappointment.

Unearned Guilt: Driven by Distortion

Here’s a real example. I was a second-year resident, raising an eight- and four-year-old alongside my equally busy resident physician husband. I had promised my preteen sister-in-law a weekend stay at our place and planned to pick her up while I was in her town (an hour away) for my nephew’s birthday.

Something got lost in communication. My mother-in-law, whom I love, drove her all the way to our house while I was driving to theirs.

I thought, I should have communicated better. It’s my fault. I’ll make it right.

So I drove back to get her—then realized I might miss the birthday party. I shouldn’t, I told myself, and the guilt was overwhelming. So I turned around again and drove back.

In all, I logged four one-hour drives that day. Not great for my mental health, my family time, or my efficiency. But I was acting from unearned guilt, fueled by shoulds and people-pleasing.

When Guilt Becomes Adaptive

Other times, guilt is earned. It can be a helpful signal, a form of adaptive guilt, that shows us when we’ve strayed from our values. Used wisely, it can clarify who we want to be and help us make amends or realign.

Unfortunately, unearned guilt often gets mixed in.

I remember being crushed by mom guilt my intern year. When my daughter’s school scheduled a mother-daughter tea on short notice! I couldn’t make it. (Who are all of these moms who can drop anything with a week's notice? And why can't it be more proactively planned?!)

Our beloved nanny, who adored our kids, was going to go in my place to assuage my guilt. But she forgot.

She shouldn’t have forgotten, I thought. And in a wave of resentment and frustration, I fired her on the spot.

And then I was left with guilt for having done so (and, also, regret for getting us into a real pickle 😬).

That guilt from my reaction to fire her was adaptive. It helped me recognize that’s not who I want to be. It helped me apologize once I’d cooled down, without any expectation she would accept it. And it helped me work on being less reactive going forward.

At the same time, the unearned guilt was loud. I was holding myself to an impossible ideal, to be always present for my kids and always present for my career. And ultimately, that’s why the overreaction occurred.

Trying to be a perfect mom and a perfect resident meant I expected myself to be fully present at all times, with my family and with my patients. That’s a feat one person simply cannot accomplish. It’s physically impossible to be in two places at once.

That kind of guilt, the kind rooted in unrealistic expectations, isn’t adaptive. It serves no purpose. (And expecting a perfect substitute isn’t realistic either. We’re all fallible.)

We can strive for excellence in both childcare and healthcare without branding ourselves as failures when we bump into the limits of our humanness, or the laws of science.

How to Tell the Difference

When guilt hits, try pausing long enough to ask:

• Is this a signal I’ve acted out of alignment with my values? If so, what do I want to do with that knowledge?

• Or is it coming from maladaptive perfectionism, shoulds, or unrealistic ideals/expectations?

If it’s the former, make a note. Learn from it. That’s growth.
If it’s the latter, name it, challenge it, and let it go. Grace applies to you, too.

You, like those around you, are human, and therefore imperfect.

Let go of the ironclad rules. Learn what you need to. And keep becoming.

If this topic resonates, you might also like Over-reliance on External Validation and What the Heck Does it Mean to Process Emotions?

Have a joy-filled day,
Tonya

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