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Medicine Rewards Self-Sacrifice Often At The Cost Of Physician Happiness

Discussion in 'Hospital' started by The Good Doctor, Sep 2, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    We’ve all been told by a well-meaning friend, family member, or therapist, “You can’t care for others unless you care for yourself first.” Put your oxygen mask on first, blah blah. But in medical training, we repeatedly demonstrate that, unfortunately, you can provide great care for patients while neglecting yourself. Medicine rewards self-sacrifice and hard work, often at the cost of physician happiness or wholeness.

    Maybe it starts in undergraduate school, when we enroll in “weed-out” classes; the phrase itself implies that we are pulling out “bad weeds,” leaving only a flourishing garden. And what grows in that garden? Motivation and intellect, sure. But also an emphasis on external measures of success above other priorities. On homogeneity above life experience.

    We arrive at medical school, where despite a pass/fail curriculum, the days leading up to every exam hang clouds of doubt over our heads. I had barely heard the phrase “imposter syndrome” until I came to medical school, where suddenly it tumbled out of mouths with an astounding frequency, and became the malady that was most familiar to us. These were the mouths of classmates who led antiracism movements, spent hours serving patients at the free clinic, made their patients feel like family — people who deserve to feel worthy of this profession.

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    Our board exam scores then placed us into categories of the haves and have nots and told us what we could and could not do. Finally, we arrived at the wards — to practice real medicine! To contribute to the team! Where our role is that of the student being evaluated. What felt like a calling before becomes a performance. A desynchrony develops, wherein the things that give our lives and work meaning – getting to know our patients’ families; bringing their wishes to fruition; supporting them at the end of life; hugging our partners; holding our kids – are not openly valued. There is little incentive for us to be well besides our own souls asking to be nurtured.

    As a third-year on my gynecologic oncology rotation, my fellow medical student and I “took a break” from hours watching robotic surgery to just talk to our patients, without an agenda, not searching for any data to report. We wondered aloud if we would get negative feedback for spending time outside the OR, not running the list, but we decided we didn’t care. It was my favorite day on the rotation, hearing our patients’ stories, reassuring them in pre-op, bearing witness to their experience. While I was told to “consult palliative” more times than I can count as a third-year, my attending and advisor empowered me to have my own goals of care conversations with patients that I had come to know well, asking what they wanted life, and the end of life, to look like. On my surgery rotation, I found myself alone with a senior attending whom I found very intimidating when the resident had to step out of a case. He spent 30 minutes teaching me to sew up a lip, exuding kindness and patience: “No, no, remember to pull your arm back — yes, just like that, absolutely beautiful.”

    When my patient at the VA unexpectedly passed away, my attending put no limits on our time spent debriefing and grieving the next morning. He wondered if he was to blame, echoing the fears going through all our minds. When a mistake really was made in my patient’s care, my attending took full responsibility, despite it not being her fault, showing us how to say sorry, how to be accountable, and how to put ego below righteousness. When my patient got extremely sick post-transplant — her family asking me whether she was going to die — my attending listened to me, and took my ideas into account, presenting them to his colleagues and implementing them in her treatment plan.

    These moments were undeniably the most impactful, defining moments of medical school for me. Imagine what our world would look like if we committed to making these moments the rule, and not the exception, for future physicians in training.

    At our white coat ceremony 4, 5, or 8 years ago, we recited the Hippocratic Oath, pledging to do no harm to our patients. I like to think we make it a focus of our education to abide by this oath to the best of our abilities. But when do we take an oath to do no harm to ourselves, or to each other? We talk about burnout and our system being broken, but the solutions we are given are individual. Meditate. Do yoga. Exercise. I think we all know that yoga is not wellness. You cannot be well, if the work that brings you joy and drives your passion also dehumanizes you.

    Well, there are thousands of us across the country now entering different specialties at different institutions. What if we took a different kind of oath? What if, alongside Hippocrates, we channeled some Brené Brown, and pledged to nurture empathy and self-compassion?

    Here is what I pledge to work on:

    I will congratulate my team members for getting to know their patients’ families, and holding their hands, as much as I validate them for knowing cranial nerve anatomy.

    I will introduce new team members to one another, and to patients, and not normalize them feigning non-existence in the background of patient rooms.

    When a patient dies, I will talk to my team about it. I will not pretend it never happened.

    When a national tragedy happens, when the burden of systemic racism feels particularly heavy on my teammates — I will acknowledge it rather than going about business as usual.

    I will remember that obedience and politeness do not always equal kindness.

    I will try to speak up against injustice, though I know it will be difficult and require bravery.

    I will say sorry – to my patients, to my colleagues, and to my family, when I could have done better.

    I will prioritize my family and normalize others doing so, whether that means advocating for fair parental leave, space for pumping, or time off for important family events.

    I will prioritize self-awareness. I will ask myself the why behind my actions, and my feelings, to ensure my motivations are decent. I will examine what I can and can’t control, make changes where I can, and work to let the rest go.

    We may not be successful at these tenets every day. Certainly not the first year of residency. But one day, when we are attendings, or chief residents, or just interns with medical students reporting to us, maybe we can truly nurture a garden that flourishes, weeds and all.

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