The distress of doctors and nurses working in hospitals during the COVID-19 pandemic has received much attention in news media and academic research, including their moral distress witnessing so many deaths at times when they could offer so little. Much less attention has been paid to the moral distress of clinicians working in other settings during the pandemic.
Using data from a survey of more than 2,000 primary care, dental, and behavioral health clinicians who work with low income patients in safety net clinics, UNC School of Medicine’s Donald Pathman, MD, MPH, found that nearly 72 percent reported experiencing either mild or intense levels of moral distress during the first year of the pandemic due to limits on what they could do for their patients, witnessing their patients’ struggles and the challenges of their own work situations.
This analysis, published in BMJ Open, was conducted from data late in 2020 from practices in 20 states.
“Most people receive their health care in office settings, and many clinicians working there experienced moral distress from how the pandemic limited the care they could provide to patients and from witnessing the pandemic’s effects on patients and coworkers,” said lead author Donald Pathman, MD, MPH, a professor in the UNC Department of Family Medicine.
Moral distress was defined in the survey as when one witnesses or does things that contradict deeply held moral and ethical beliefs and expectations. “Moral distress is a concept developed to understand the consequences of disturbing situations nurses can experience in hospitals, but the concept of moral distress is likely just as useful in understanding a type of distress clinicians in all disciplines and work settings experience,” Pathman said.
Respondents in the survey were 2,073 clinicians who work in community health centers, mental health facilities and other types of safety net clinics that provide care to low income patients who face barriers to receiving care in the mainstream U.S. healthcare system. Many of these patients are also members of racial-ethnic minority groups.
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