Table 4.

Nephrology fellows’ comments regarding moral distress during their fellowship

Regarding futility of care

Having to go into the hospital overnight to see a patient for urgent dialysis who is well known to our nephrology practice to be a very noncompliant dialysis patient. The patient will then undergo dialysis as the patient pleases (i.e., shorten dialysis from the prescribed 3–2 h or refuses dialysis altogether even though the fellow drives in to see the patient overnight). However, because the patient is a patient of the attending physicians at the practice, fellows are forced to see them though there is futility in doing so. This has occurred twice (to my colleagues) in my first 3 months of fellowship

Dealing with critically ill and dying patients of any stripe causes some moral injury and sometimes distress

On a heavy service, I had about one patient dying every 2 days for 2 weeks in a row (i.e., about 8 deaths). This caused me a lot of moral distress, and it made me question the purpose of all we do. It was difficult to talk about this with anyone and I felt very lonely

Regarding power dynamics

Being bullied and abused by faculty – beyond extremely stressful

In relationship to what is stated above, I feel moral distress when I experience inconsistencies amongst different providers about appropriate scenarios to go see the patient overnight. Some attendings prefer all patients to be seen, no matter how urgent or nonurgent the consultation may be, while others are more reasonable. I think it’s disturbing that fellows are used in this manner. I suggest that if the fellow must go in to see the patient at night, the attending should as well as supervision