Interpersonal

Bias toward specific medical conditions or populations

Communication barriers (e.g., language, literacy, poor rapport)

Differing expectations from patients (e.g., goals of visit, expected results)

Lack of trust

Situational

Inadequate training

Lack of resiliency

Personal health issues (e.g., mental health condition)

Physician insecurity about their medical knowledge

Sleep deprivation

Systemic

Corporatization of medicine (i.e., inadequate time for patient care)

Increased documentation requirements

Lack of staff support and resources

Moral injury (the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control)

Social determinants of health (health-related social needs, including housing instability and nutritional insecurity)

Systemic racism (systemic unfairness that leads to socio-economic and health disparities for patients)