I used to be haunted by moral distress, but it's an emotion I've now learned to live with.

I still remember the shock of understanding I experienced my second year of residency when I first

learned the term.

There's a power that comes with knowing what you're up against.

I realized that what I was going through was an burnout or depression or self-doubt.

Instead, I had come to believe that sometimes things go the wrong way.

With understanding comes the potential for change.

Part of my work these days is as an ethics consultant, and when I take calls I find that while sometimes people struggle to

articulate an ethics question they know when something feels wrong and

guided by their moral intuition and the values of the patient and family they care for, we work together to define the problem and seek solutions.

The care plan doesn't always change, but gathering and speaking openly is itself a powerful process.

Welcome back to Add the Bedside.

I'm Margot Hedlund, a hospitalist and clinical ethics consultant.

I'm Joffere al-Mandri, a medical oncologist.

And I'm Tamar Schiff. I trained in internal medicine and am currently a post-op and bioethics.

In our last episode, we spoke about moral distress, which we defined as the stress we feel when we're blocked from acting on our moral convictions.

We also spoke about other key concepts like moral residue and moral injury as well as

some of their causes and consequences. In part two we want to talk about some

strategies for addressing moral distress. We're back now with Dr Beth Epstein, professor of nursing and ethics consultant at the University of Virginia,

along with Dr. Wendy Dean, a former psychiatrist who has become a leading author, advocate and podcaster on the topic of moral distress and moral injury in medicine.

Dr. Epstein will help us break down

more of those immediate patient care and teams-based issues

...