Moral distress: The cost of uncertainty during a pandemic

Message from Dr. Debra Boyce, CMPA President

Originally published June 2020

Each day, the CMPA hears from physicians struggling with the COVID-19 pandemic. While we all have unique practice and life situations, it’s clear that the crisis is placing unprecedented strain on all of us. It’s impacting us both as physicians and as human beings by creating overwhelming uncertainty. I’ve witnessed firsthand—as the president of the CMPA and in my own family medicine practice—how difficult it is to practise medicine when there are so many unknowns.

We have so many questions with few, if any, answers:

  • How can we keep up with the evolving signs, symptoms, tests, and treatments for a disease we only heard of recently?
  • Will we catch it ourselves? Could we bring it home to our loved ones, or spread it to our patients, staff or colleagues?
  • If there is a surge of infected patients, how will we allot scarce resources such as ventilators and personal protective equipment?
  • How can we treat patients who need care and procedures now deemed non-essential, and how will we manage the backlog when non-essential treatments resume?
  • Can we successfully provide virtual care when we feel more confident seeing patients in person?

Giving ourselves permission to feel the impact

Uncertain situations such as we’re facing now can make us feel vulnerable, anxious, fearful, or stressed. Even if we don’t think COVID-19 is affecting us, it likely is. The unknowns in our particular circumstances and the resulting emotions can lead to moral distress, a core-level sense that we are unable to fulfil what we believe is the ethically appropriate or the right course of action.

The CMPA’s second podcast in its COVID-19 series discusses the moral distress we experience from facing ethical dilemmas. It examines how repeated situations of moral distress can leave a lasting effect, a moral residue that can then heighten moral distress in other situations. I encourage you all to take a moment to listen.

To help lessen moral distress, I believe we must first acknowledge the personal cost of the pandemic and be alert to the risks to our health and wellness. As a group, we physicians tend to “soldier on” when things get tough, often at the cost of our wellbeing. We must give ourselves permission to be human and treat ourselves with compassion. We must recognize that the uncertainty created by the pandemic is affecting our health now and may continue to affect it later.

We need strategies for staying well

If possible, I urge all of us to adopt one or more of the many strategies for staying healthy that can be found on the CMPA’s Resources for staying well during COVID-19. It’s critical that we create the support and networks necessary to discuss the impacts now, and to be alert to the impacts down the road. Here are a just a few I think we need to consider:

As individuals:

  • Recognize that each of us feels the impact differently based on our core values and our sense of equity or fairness.
  • As much as possible, look after the basics: eat well, hydrate, take breaks, and get rest.
  • Pace ourselves. Recognize that the pandemic may continue for a while and our personal energy is not limitless.

As teams:

  • Be aware that uncertain standards of care and changing science bring distress to team and organizational discussions and encounters. We learn how different we are as individuals, when we face such dilemmas.
  • Create a buddy system. That is, have members of your team find a trusted person (colleague, friend, team member) to talk to about emotions and experiences. Open up communications and share stories about experiences.
  • Where possible, either virtually or in cases of those on the frontlines in person, try to foster a sense of community and connections at work [PDF]. Greet your colleagues when you see them; ask how they are doing. Offer to help as needed, and reach out to ask for help.

As organizations:

  • Focus on the longer-term occupational capacity rather than short-term crisis response.
  • Reassure staff with good quality communications and accurate information updates.

At all levels, we need to recognize and celebrate our wins and the lessons learned.

We can rely on the CMPA’s support

As the pandemic continues, and we focus on caring for others, some of us may not have time to address our own needs, but we will all need support and healing in the coming days and months. Throughout this process, the CMPA will be there.

With all the changes and uncertainty introduced by COVID-19, I know that the enduring strength of the CMPA and the confidence and courage it brings to Canadian physician members is essential. The Association recognizes the distress that was, and is, being experienced. It will be there for us. It will respond, advise, assist, and educate in the ways it always has and in new ways demanded by the new normal. We will figure out what that is together.

Debra E. Boyce, BSc, MD, CCFP, FCFP
CMPA President