I was doing the dishes recently when I was hit with a stomach-dropping sensation and an unprompted memory. A negotiation I’d had years ago with my department. I had secured fair compensation for work they needed done, using the leverage I had. I walked away feeling good about it. And yet, standing at the sink with my guard down, years later, I felt a flash of guilt so unexpected it took me a moment to recognize it.

Guilt. About a successful negotiation.

A lot of doctors carry around guilt. A 2025 scoping review by Cameron et al. of 185 articles describes the guilty feeling doctors experience over the missed diagnosis, the bad outcome, the patient lost. But I hadn’t missed a diagnosis. So, what was behind my guilty feeling?

I call these “kitchen sink moments”: When something painful surfaces before you can push it down. Usually, we’re too busy and too defended to feel them. But when doing the dishes, sitting in traffic, laying our heads on the pillow, our guard drops. Freud called this the return of the repressed, the way buried feelings find us when our defenses are down. What bubbles up is disproportionate, resistant to logic, and very old.

For many physicians, it originates in childhood. And physicians aren’t the only ones who carry it. Ask any woman, anyone raised Catholic, or any child of an alcoholic, of which I happen to be all three.

I grew up the middle child in a home with two very young parents who mostly didn’t get along. My father was an alcoholic, eventually in recovery. Both carried unresolved resentments. And I, like many children suffering their parents’ limitations, developed an unconscious conviction that I was responsible. That if I were better, more helpful, more achieving, less needy, I could fix it. I poured that conviction into school, into sports, into being the kind of child who applied pride as a salve to my parents’ hurt.

I wasn’t conscious that I believed any of this. I just lived it, and it drove me to medical school.

A psychiatrist and psychoanalyst named Lawrence Blum describes the guilt physicians bring with them on day one of training. He writes about what he calls “hidden guilt”: the burden accumulated in childhood that hides underground and later resurfaces as a compulsive need to do good. Medicine doesn’t create it. It recruits for it. The selection process rewards people who arrive already prepared to sacrifice, already convinced their needs are less urgent than everyone else’s.

There is certainly nothing wrong with committing one’s life to helping others. The problem is when the medical-industrial complex exploits that impulse for profit, and when your commitments have no internal guard rails. The narrative gets inculcated: Anything you do for yourself is something a patient isn’t getting. Your time off is someone’s missed appointment. Your boundary is care unprovided. This story rings true because it maps onto something already written into our psyches.

When I took a sabbatical and then went part-time, my guilt was immense. Wasn’t I abandoning my calling? The system amplified my self-accusation. I was required to resign my position and give an exit interview (“just procedure”). Months later, at a colleague’s social event, someone who knew I was still in the department part-time looked me in the eyes and said, “You’re not with us anymore.” At a party. The system confirmed my fear that part-time was as good as gone, pressing on my exposed nerve endings of guilt.

The feeling was strangely diffuse. As an inpatient consultant with no patient panel, there were no specific patients I was abandoning, just a vague, totalizing obligation to all patients, to medicine itself. That kind of burden compels you to keep grinding away to no particular end.

Years of psychoanalysis helped me realize it wasn’t my fault that my parents weren’t happy. Rather, it was my own hidden (and therefore untreated) wound that I kept finding and treating in others. Coaching helped me let go of responsibility for saving the whole world, and then to help other doctors do the same. This is the work I do: interrogating the unconscious beliefs my clients live as truths.

The goal isn’t to eliminate guilt. When it’s proportionate and accurate, it’s useful. The goal is to build the muscle of examining it. To ask, every time it fires: Is this signaling something real, or is this the old story? And when it’s the old story, to consciously set it down and instead act from something truer.

This matters beyond your own well-being. When guilt drives, we aren’t making clinical or ethical decisions. We’re appeasing an unrelated and imaginary master. We’re avoiding the punishment we imagine is coming and deserved. We submit to administrators and insurance companies not because they are right, but because they have inherited the psychological authority of much earlier figures: our parents. We agree to add patients to an already full schedule. The institution benefits. The patients get less. The physician gets nothing. Appeasement is not the path to good care.

But when we can see it clearly, something shifts. We can ask: Is this the wounded child reacting to a system that has learned to use her unconscious self-neglect? That distinction is where agency lives. The physician who says “I won’t do that because it would compromise care” isn’t being selfish. She’s making an ethical argument from a place of clarity rather than fear. Trusting her training over the mandate.

This is where the work starts. Not in a policy change or a wellness committee, but in confronting the unguarded moment at the kitchen sink. Smoke the guilt out of its hiding spot. Make the unconscious conscious. Name what you’re carrying and where it came from. And then tell it that you have a right to exist. To be whole. To be happy. Not because of what you produce or who you save. Just because you are a person, and that has always been enough.

Christie Mulholland is a palliative care physician and certified physician development coach who helps physicians reclaim their sense of purpose and connection in medicine. Through her work at Reclaim Physician Coaching, she guides colleagues in rediscovering fulfillment in their professional lives.

At the Icahn School of Medicine, Dr. Mulholland serves as associate professor of palliative medicine and director of the Faculty Well-being Champions Program. Affiliated with Mount Sinai Hospital, she leads initiatives that advance physician well-being by reducing administrative burden and improving access to mental health resources.

Her recent scholarship includes a chapter in Empowering Wellness: Generalizable Approaches for Designing and Implementing Well-Being Initiatives Within Health Systems  and the article, “How to Support Your Organization’s Emotional PPE Needs during COVID-19.” Her peer-reviewed publications have appeared in Cancers and the Journal of Science and Innovation in Medicine.

She shares reflections on professional growth and physician well-being through Instagram, Facebook, and LinkedIn. Dr. Mulholland lives in New York City with her husband, James, and their dog, Brindi.