Do No Harm? Medical Students’ Moral Distress Witnessing Patients’ Pain and Suffering

Abstract: Prospective students enter medical school optimistic for the power of medicine to heal but are quickly faced with the limitations of medicine and paradoxical suffering associated with well-intended treatment. Specifically, the surgical clerkship is a crucible where medical students experience caring for patients’ physical bodies in a setting where “healing” may require inflicting new wounds, often precipitating patient suffering. For many students, these experiences are morally distressing as they confront, often for the first time, their own beliefs about the purpose of medicine in the setting of pain and suffering. There is ongoing debate about the definition of moral distress; some argue for the preservation of a narrow definition, in which individuals identify a morally correct action but are constrained from acting. Others advocate for a broader definition to more fully capture the breadth of morally distressing experiences. While moral distress has been well documented in medical literature, little attention has been given to medical students who may be particularly vulnerable given the medical hierarchy and their lack of training in managing distressing clinical scenarios. To explore and characterize the types of moral distress medical students experience during their surgery clerkship, we conducted a descriptive content analysis using text from a narrative medicine exercise wherein students were asked to describe an experience of witnessing patients’ pain. In this presentation, we characterize medical students’ moral distress, consider the implications on personal and professional identity formation, compare their experiences with other professional contexts, and propose opportunities to mitigate harmful effects.

Evey Aslanian, BS – University of Michigan Medical School, Ann Arbor; Janice Firn, PhD, MSW – The Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor; Emily Harlan, MD, MA – Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor; Sarah Bradley, PhD, MPH, CPH – Department of Surgery, University of Michigan, Ann Arbor; Pasithorn Suwanabol, MD, MS – Department of Surgery, University of Michigan, Ann Arbor