There are varying definitions of anger, which is a strong emotion.
The American Psychological Association defines it as “an emotion characterised by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice.
“It can manifest itself in behaviours designed to remove the object of the anger (e.g. determined action) or behaviours designed merely to express the emotion (e.g. swearing).
“Anger is distinct from, but a significant activator of, aggression, which is behaviour intended to harm someone or something.
“Despite their mutually influential relationship, anger is neither necessary nor sufficient for aggression to occur”.
Anger is both a physical and a psychological reaction.
It is a normal emotional response to a person or situation where one believes that there has been unfair treatment or has otherwise been hurtful or harmful.
Anger emerges when one feels threatened – emotionally, physically, financially or in other ways.
Many angry feelings stem from powerlessness.
When a situation cannot be corrected or improved, the frustration, sadness and other negative emotions often converge into anger.
Anger can also be associated with longstanding feelings associated with bullying, trauma, neglect, abuse, rejection, discrimination or other struggles.
All doctors are trained to manage angry patients and relatives.
It is considered unprofessional to be angry at patients.
However, doctors are humans.
Their suppressed anger does not disappear by itself; it is manifested in other ways.
One of the consequences of anger is burnout and moral injury.
Burnout and moral injury
According to the World Health Organization (WHO), burnout results from chronic workplace stress that has not been successfully managed.
This includes energy depletion or exhaustion, increased mental distance from one’s job or negativism/cynicism about work, and reduced professional efficacy.
Moral injury is the psychological distress that follows actions, or failures to act, that cross a person’s own ethical boundaries.
For example, something happened that felt like a betrayal of what a doctor is.
The term was originally developed in military psychology to describe what happens when soldiers are ordered to do things that contradict their moral code, but it applies far beyond the battlefield.
Both are invisible wounds, but they are not the same wound.
The core emotional features differ, i.e. moral injury results in guilt, shame and betrayal; burnout results in exhaustion, cynicism and disengagement.
The literature on anger in patients is voluminous, but there is less about anger in doctors and other healthcare professionals.
Examples from America
There is recent data on angry doctors in the United States.
The State of America’s Physicians: 2025 Wellbeing Survey, involving over 1,000 doctors, found that 57% had experienced inappropriate feelings of anger, tearfulness or anxiety, and 34% reported they felt hopeless or had no purpose, during 2024, similar to the 2021 and 2022 pandemic levels.
Fifty-five percent had felt levels of debilitating stress, while 46% reported withdrawing from family/friends/co-workers.
The consequences for the doctors were wide-ranging and included:
- Emotional withdrawal and reduced engagement with colleagues and family
- Increased risk of burnout and mental health issues, including anxiety and depression, and
- Stigma surrounding mental health care, with 73% acknowledging stigma and 38% avoiding care due to concerns about licensure or credentialing.
A survey of 55,000 healthcare professionals, including doctors, presented in the 2023 Annual Research Meeting of Academy Health reported that “40% of respondents felt angry either some of the time, most of the time or all the time.
“Fifty-five percent of physicians and nurses reporting feeling angry – a percentage higher than those reporting other jobs.
“More nurses (59%) than physicians or physician assistants (53%) reported that feelings of anger sometimes or often prevented the person from thinking in a clear-headed way”.
The doctors’ anger was due to a combination of systemic, administrative and patient-related factors.
The main contributors included:
- Time constraints and high patient volume with limited time for meaningful interactions with patients
- Staff shortages, excessive paperwork, increasing workload and reducing autonomy
- Insurance restrictions complicating care delivery
- Patient anger, especially in high pressure units like emergency departments, and
- Public misinformation and disillusionment with the healthcare system.
It is uncommon for doctors to take out their anger on patients.
An experiment involving 134 emergency doctors encountering patients with display of irritable behaviour in Massachusetts, US, concluded: “Although patients’ irritable behaviours adversely influenced physicians’ emotions, engagement and patient assessments, they did not affect the quality of care provided (i.e. clinical decisions, behaviour, diagnostic accuracy)...
“Physicians’ reactions to patients displaying irritable behaviours may reduce the quality of physician-patient relationships (e.g. reduce trust, effective communication) and contribute to physician burnout – both of which can compromise patient care”.
In Malaysia
No large scale studies about doctors’ anger in Malaysia are available.
However, there is ample data that speaks for itself.
The healthcare workforce situation in the Health Ministry is less than satisfactory.
Fewer doctors are doing housemanship.
Medical Officer shortages, even in major hospitals, have impacted service delivery.
Many doctors have declined appointments to permanent posts.
Specialists continue to leave civil service.
Some hospitals function at much less than their physical capacity because of staff limitations.
Many staff members face mental health problems.
And worse still, many doctors are leaving the profession or joining healthcare facilities abroad.
All this at a time when the population’s demand for healthcare is increasing markedly.
It is no different in the private sector.
Non-doctors are interfering with patient care.
In a 2025 survey of more than 855 private sector specialists, 99% perceived interference with clinical decision-making, violating clinical autonomy, with 49.6% reporting “frequent” interference and 43.6% “sometimes”.
Ninety-nine percent reported that their patients had problems with health insurance companies and third-party administrators (TPAs), with the tag line “Delay, Deny and Revoke” summing up the situation.
Private sector specialists’ fees have not been reviewed since 2013 and the general practitioner (GP) fee schedule since 2006, except for a paltry increase in 2025 to RM80 maximum consultation fee – a figure about half of what a plumber or electrician receives for a home visit.
Yet, there are more regulatory and administrative impositions on doctors.
More is required for less.
The situation is no better in the nursing profession.
A 2019 study of 2,428 nurses in 32 public hospitals and 28 district health offices found that: “One in four (24.4%) nurses experienced burnout.
“Younger, single and childless nurses had a higher prevalence of burnout.
“Shift-working nurses were 1.6 times more likely to develop burnout.
“Those who had more than six night shifts per month were 1.5 times more predisposed to burnout.
“While encountering traumatic events at work led to 4.2 times higher risk of burnout, those who received post-traumatic psychological support were better protected”.
Writing on the wall
Consider the consequences.
Too few housemen lead to too few Medical Officers, and consequently, specialists and sub-specialists in both public and private sectors over a period of time.
Patients move from public to private care not because they have become richer, but because of long waiting lists, delayed surgeries etc.
Many patients and families have become bankrupt because of healthcare, particularly when serious conditions like cancer, stroke etc, affect them or their family member.
The Malaysian healthcare system is going the American way, where healthcare is now capital care measured in terms of return of investment (ROI).
This columnist has not encountered such intensity of anger or discontent among doctors since he started practice decades ago.
The writing is not just on the wall; it is playing out in real time almost daily.
The claim attributed to a senior government official that if there is a spirit of nationalism, junior doctors’ issues can be overcome, is at best, pathetic.
With such a mindset, one wonders how problems can ever be solved.
During the Covid-19 pandemic, doctors and nurses provided care to patients whom they did not know at great risk to themselves and their families.
Some doctors and nurses died doing so.
Modelling suggests that the next pandemic will come sooner than later.
Will angry doctors and nurses provide the same level of care when that happens?
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
