You’re doing everything you possibly could do, and you know it’s not enough”: Family physician narratives of moral distress

Abstract

Background: Family physicians (general practitioners) working with patients experiencing social inequities have witnessed their patients’ health care needs proliferate. This increase in patient need, paired with increased workload demands fostered within current remuneration structures, has generated concerning reports of family physician attrition, and possible experiences of moral distress. Aim: The purpose of this study was to explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities. Design and Setting: Conducted in Ontario, Canada, this study was a critical narrative inquiry informed by the analytic lens of moral distress. Method: Twenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews, and had the opportunity to review the interview transcripts. Results: Family physician accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programs. These structural elements left physicians unable to get patients much needed supports and resources. Conclusion: This study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs due to structural features of the Canadian health and social welfare system. This finding provides impetus for critically interrogating how health and social welfare systems internationally must be reformed to both improve the health of patients, and increase family physician professional quality of life, potentially improving retention.