Silent Wounds of Medical Betrayal

Betrayal in medicine, patients and physician harm


Betrayal occupies a unique space in the human experience, as anyone who has felt betrayed knows all too well. In the healthcare environment, it represents one of the most ethically charged and psychologically damaging forms of a relational breakdown. From this perspective, it is very different from romantic betrayal or interpersonal treachery. It is a breach of trust and responsibility, a sorry manifestation of the power imbalance that exists between physicians and their patients. In this first of several short essays on the subject, I address the silent wounds of medical betrayal on the perpetrators themselves.

Medical care is both highly technical and grounded in an often obscure and changing clinical science.  While most physicians do what they believe is in their patients’ best interests, some jeopardize their personal and professional integrity to comply with institutional guidelines, a mentor’s instructions, financial obligations, political positions, or their perceived need to embrace technological advances before supporting scientific evidence is established. 

Knowingly providing suboptimal medical care, failing to disclose conflicts of interest, or making misleading statements or false promises are just a few ways physicians betray their patients’ trust. But there are others. Alfred Tauber, author of Confessions of a Medical Man, for example, wrote of the dangers of the physician-technocrat who turns medical care into a business transaction, and Oliver Sacks, in A Leg to Stand On, described the devastating emotional impact on patients who feel abandoned by their caregivers.

When doctors nonchalantly neglect a patient’s humanity, however, they do more than a disservice to their profession and their patients. An act of betrayal shatters the moral basis of professional obligation, the ethical foundation that resides in a fiduciary trust built on a patient’s vulnerability and the physician’s promise of beneficence. For the perpetrator (is that too strong a word?) professional burnout, cynicism, and a growing sense of personal failure can ensue, with long-term effects on a health care provider’s mental health.

The emotional consequences for the instigator of such betrayals, whether the betrayal is of a patient or of the ethical obligations of the profession, are what psychologists call self-inflicted moral injuries. Shame and guilt, self-disgust, emotional exhaustion, and detachment from colleagues and patients can lead to increased feelings of anxiety or depression, substance abuse, and sleep disruption. Over time, these and others may lead to developing a distorted sense of professional obligations, poor performance, and loss of credibility. 

The effects of self-inflicted moral injury on one’s sense of meaning, purpose, and personal identity can be devastating. They may lead to abandoning the health care profession, and in worst case scenarios, to excessive drug and alcohol consumption, disruption of the nuclear family, and even suicide.

Committing an act of medical betrayal causes a silent wound that easily grows over time. The old adage, to forgive and forget, does not readily apply, and often, this wound requires professional help to heal.