Table 3.
Categories of morally distressing issues with representative comments (n=508 comments)
| Morally distressing issue category | Representative comments |
| Within the clinic | |
| Patients not receiving the best and/or needed care (n=145; 29% of all issues) |
Performing telehealth visits that really require in person evaluation; Not having the resources to always help my patients; telling people they couldn't have dental care because it wasn't emergent; Not able to provide the quality of care I would like to |
| Risking infecting patients and/or clinic staff (n=97; 19% of all issues) |
Worrying about infecting others with covid if i am asymptomatic; Had to reuse N95 mask for two to four weeks; Assuring my family health with client’s not following protocol (including masks); My clinic wasn't telling staff or clients when there were positive covid cases in the building and I was told not to as well. |
| Abuse of staff or ignoring their needs (n=37; 7% of all issues) |
Overworking staff; Lack of support/appreciation from administration; Lack of PTO being allowed; Feeling like my safety and the safety of my team is not a priority and we are not valued except to keep money coming in… |
| The suffering of patients (n=36; 7% of all issues) |
Patients passing away from Covid, huge number of them infected; Increased use of drugs/alcohol as a coping mechanism by patients; Listening to patients who have been affected by the pandemic |
| The suffering of clinic staff (n=28; 6% of all issues) |
Uncertainty of employment; Being unable to validate some of my team when they are struggling; Work stress; Colleagues getting sick or having family members die. |
| Inequities for patients (n=8; 2% of all issues) |
Seeing how my patient population has been disproportionately affected by illness and death because of socioeconomic issues; Seeing patients unable to get their healthcare needs met due to financial circumstances, inability to obtain health insurance, loss of income, etc… |
| Within the community | |
| Politics in the community (n=30; 6% of all issues) |
Political approach to the pandemic; Politicians behavior, behavior of their supports; politics and collision with medicine/science |
| The suffering of people in the community (n=27; 5% of all issues) |
Hearing or seeing others struggle; increase in poverty and suicides; Forced lock downs; knowing that elderly people in nursing homes were contracting and dying from the virus due to employees or family members infecting them. Very sad and irresponsible. |
| Inequities and injustice within the community (n=25; 5% of all issues) |
racial injustice, lack of access to healthcare; The disproportionate effect of COVID-19 on minority and impoverished communities; The ongoing racism and racial inequality experienced by BIPOC. |
| Risking infecting people in the community (n=22; 4% of all issues) |
Lack of community commitment for COVID safeguards; Lack of social responsibility of others to wear a mask; Lack of compliance with CDC recommendations in my community… |
| Unclear issues | |
| Unclear/uncertain/other issue (n=53; 10% of all issues) |
My patients; Helping to run the COVID clinic; decisions made by management; Being asked to screen patients for covid symptoms despite no medical training; COVID 19 vaccines |