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If You’re a Doctor or Nurse, Don’t Feel Guilty for Quitting

Doctors and nurses who face “moral distress” about caring for ungrateful, disrespectful patients should rethink their view of what they owe patients.

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As the U.S. passes the grim toll of 1 million deaths from Covid, we must pause to reflect on the cost paid by those still living, in particular, by the nation’s health care workers. In the last Covid surge, many hospitals were pressed to the limit, not just by the influx of patients but also by staffing shortages. Doctors and nurses were not only getting sick but deciding to call it quits.

If you’re one of the 20 percent of health care workers who have been thinking about quitting, you have my sympathy.

Because our health care system was seriously underprepared for this pandemic, those of you on the front line have had to fight it with totally inadequate resources. But how much of your current stress is also due to anger about being disrespected by the people you work with, including your patients?   

If some part of your stress is due to such anger, you can empathize with Molly Phelps, an emergency room physician profiled in a recent article by Ed Yong in The Atlantic. Phelps thought she was willing to put up with the misery she faced in Covid wards, but quit after she became demoralized not only by hospital administrators who “never acknowledged what we went through” but also by the patients who “seemed to forget their humanity.”

These were mostly the unvaccinated patients who were belligerent and uncompliant with doctors’ medical instructions. Some demanded treatments with no known basis, some were even violent. Between their behavior and the fact that they could have avoided hospitalization by getting vaccinated, it must have been hard to feel compassion for them. As Yong puts it, “For a health-care worker, being shaken by a patient’s death comes with the job. Finding yourself unmoved is almost worse.”

Yong cites a director of National Nurses United who diagnoses many health care workers with a kind of “moral distress”: “the anguish of being unable to take the course of action that you know is right.”

Many different factors could cause “moral distress” for today’s doctors treating Covid patients. But if you feel this distress specifically because you are unmoved to care for ungrateful patients, you owe it to yourself to think about whether it really is bad to feel this way.

If you think you should feel moved to care even for irrational, disrespectful patients, you must think you have a duty to care for every patient you encounter, no matter who they are or why they are unwell. So many of us are taught from a young age that the essence of morality is unconditional selfless service to others. It’s the same doctrine that leads many to say that society should provide health care to all, that everyone has a “right to health care,” regardless of their ability to pay, regardless of whether their inability to pay is the result of bad luck or their own financial irresponsibility.

But you are now facing the ultimate consequences of that doctrine: patients who also accept it, think they have the right to demand your unconditional service, even when they could have avoided the need for treatment.

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If you’re unmoved to help them, it’s because some part of you must realize that you’re not a natural resource to be exploited, but a person who worked hard to develop your expertise. This part knows that patients who have gotten sick because they don’t believe in your expertise are getting what they deserve. You must realize that they of all people have no right to demand your unconditional service.

So if you feel anguish that you don’t care about them, please consider that maybe you shouldn’t. Maybe the ideal that says you should is wrong. So, instead of caring about them, you actually have good reason to find them contemptible.  

I would bet that some part of you knows why your anger is justified: the part of you that wanted to enter this field in the first place, the part that knows and values the work it took to acquire the expertise these patients disparage. You valued that work because you enjoyed the challenge inherent in solving medical problems. You found deep personal fulfillment in pursuing the truth about human health, not in some ideal of selflessly serving those who don’t care about the truth. All trades create value for others: you entered this one because of the joy you hoped to find in acquiring knowledge of this field and applying it to real problems.

If you were looking for that kind of personal fulfillment, your anger is amply justified. The problem is not that you’re unable to care about ingrates, it’s the ingrates themselves. A career is only fulfilling when it’s sustainable: being compensated for doing something you love feeds your ability to do more of it, and to do it better. And it’s not just monetary compensation that matters. It’s the gratitude of your customers — your patients — who recognize the value you create for them.

Of course, as a doctor you’re not always in a position to pick and choose your patients. My point is not that you can or should arbitrarily refuse patients. It’s that if you can’t find a way to make the joy of solving medical problems overcome the pain of being treated with disrespect, you shouldn’t blame yourself if you want to quit. 

I, for one, won’t blame you if you do quit out of righteous indignation for being treated like chattel. I still hope you don’t quit: many others and I may need your help. But you don’t owe it to us. And if some people don’t see that, they deserve what they get.

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Ben Bayer

Ben Bayer, PhD in philosophy and formerly a professor, is a fellow and director of content at the Ayn Rand Institute. Ben is an associate editor of New Ideal.

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