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Guilt as a resident physician

Let’s talk guilt.  Many in medicine excel in this emotion, especially residents. Mom guilt. Partner guilt. Friend guilt. Doctor guilt.  Food guilt. Work-out guilt. It stems from a couple of places. 


One root is that many of us high achievers are wracked with unhealthy perfectionism.  We want to be perfect as a physician – and for family medicine, that means cradle to grave, inpatient, outpatient, prenatal care and labor and delivery, rural and urban.  We want to be perfect as a friend, partner, spouse, parent.  We want to be a perfect mentor to students or interns.  We want to be perfect parents, neighbors, community advocates. We may never intentionally think to ourselves – “I want to be perfect,” but we show our colors when something we do is “less than.” We think something has gone wrong. We are very hard on ourselves.


Perfectionism is a close cousin to the “should/shouldn’t” statement thought distortion.  I should have checked the magnesium yesterday when we couldn’t get the potassium up. I should have left work on time to spend more time with loved ones.  I shouldn’t have forgotten their birthday.  I should call…. You get the picture.


This particular thought distortion appears to be useful and helpful. But it's not. We think of it as a good motivating statement. But that’s not reality. When directed at ourselves, should statements creates guilt, defeat, frustration, and anxiety. And those emotions drive us to worsen our state or others. When directed at others, they can lead to anger, frustration, resentment, or disappointment.


Once, I had promised my pre-teen sister-in-law she could stay with us for the weekend.  I planned to pick her up where she lived in a town an hour away since I would be there for my nephew’s first birthday party. Communication evidently didn’t go well.  (I was a 2nd year resident with a 9- and 5-year-old and busy resident physician husband, so who knows what was communicated.) Anyway, my mother-in-law, whom I love, drove all the way to our house to deliver my sister-in-law while I drove to her house.  “I should have communicated better.”  It’s my fault; I won’t let her feel like the drive was a waste.  So, I drove back. I entertained missing my 1-year old nephew’s birthday. Then I thought, "I shouldn’t," and the guilt was overwhelming. So, I drove back with my sister-in-law to attend the party. In all, 4 one-hour trips, as a busy second-year resident mom, was not good for my mental health or my time management, but it was all driven by “should’s” and guilt with a little bit of people-pleasing thrown in. 


Guilt not only leads to poor decisions for our own mental health but often leads to poor decisions regarding others.  I was weighed down with mom guilt about working so much as a resident my intern year.  My oldest daughter’s school notified us last minute of the mother-daughter tea.  (Do schools think all kids have parents that can drop everything with 10 days' notice?) Anyway, we had an amazing nanny who loved our kids dearly. The plan was for her to go in my place, so my daughter had someone with her for the tea. The problem was she forgot. She shouldn't have forgotten. My own mom guilt and shame turned into anger, and I fired her on the spot. Shoulds and guilt drove a poor decision that affected my nanny, my kids, and me in a big way. 


So, when you’re feeling guilty, step back. Ask yourself what’s driving it? Is it something you learned you want to do differently next time? Then make a note and move on. ("You know this was a good reminder, when the K* is low, I'll check a Mg). Often, it’s an underlying thought distortion or unrealistic expectations of yourself or others. Remember, you, like those around you, are human and therefore imperfect. Give yourself and them grace.  And get rid of iron-clad rules you have for yourself and others. 


Have a joy-filled day – Tonya

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