We want our doctors to be perfect, but they’re human too

Though there are few subjects as immediate to my experience as that described in Gardiner Harris’s article in The New York Times, “More Doctors Say No to Endless Workdays,”  perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn’t feel much need to read the rest of the article.  More doctors say no to endless workdays? Well, of course we do.  Duh.

For those who (like me initially) read little more of the article beyond the first few sentences, it details, in the context of a three-generation medical dynasty, the “sweeping cultural overhaul of medicine’s traditional ethos.” Today’s generation of physicians is choosing to limit their work-hours, altering the scope of their practice, and deciding to concentrate of medical specialties based on lifestyle choices as much as interest in the medicine itself.  In essence, the current crop of young doctors is recalibrating the personal and professional expectations set by our predecessors, taking the radical stance that the work-life balance applicable to all other professionals might possibly be applied to us as well.

Not surprisingly, the original article sparked an outpouring of discussion, with viewpoints as polarized as the face of healthcare itself.  “Who can blame young physicians for choosing a more flexible work-life balance?” one reader from Austin, TX writes, citing the long hours and sacrifice inherent in medical school and residency.  Another commenter opines that she would rather be cared for by a physician “…who is not overwhelmed, not heading towards burn out, someone who can still love their job because they have time to have a life.”

On the opposite end, a reader from Philadelphia, PA chides, “I am not terribly sympathetic to physicians when they complain about their working conditions. What did they think they were getting into?”  Another commenter expresses that an older generation of physicians, who sometimes worked ceaselessly for days at a time and “never hesitated to sacrifice anything and everything for the good of their community” were the true and noble face of medicine, and that younger doctors seeking less than complete devotion to their chosen fields were merely “selfish imitations of real physicians.”  Fascinated and occasionally mortified, I read through every single online response to the article, and though I was occasionally taken aback, no one opinion ever truly surprised me, because I’ve heard each of them many times before–from other doctors, from patients, and from my own mouth.

First a little background to give some perspective on where I stand and why I stand there.  I am a relatively young physician, eight years out of medical school, less than three years out of residency.  I started my medical training in a primary care field–specifically, pediatrics–but after two years, switched to the subspecialty field of anesthesiology.  I made this switch partly because I learned over time that my interests and strengths leaned more towards acute subspecialty care than long-term outpatient care, and anesthesiology was one of the fields that offered the unique mix of immediacy and hands-on skill that I craved.  But also, Anesthesiology is a field that offered more flexibility in balancing the work life I already had with the family life I hoped for in the future.  I had my first child early my first year of anesthesia residency, and six months after graduating, I had my second.  My sons are now two and five and-a-half years-old (the half is important, he’ll have you know), and I am working a full-time job as an anesthesiologist in a private practice.

I tell you all this not to invite judgment of my choices or values (though I am familiar enough with the experience of writing for an audience that some people will take it as just that–an invitation), but to let you know that I know of what I speak.  Having gone through the long winding path of medical training, having made the choices I’ve made, and living the life I do every day, I am intimately aware of the constant struggle between my duties as a physician and my duties to my family.  I try to control what factors I can, but all too often the needs of both–each billed to me as the most important thing I will ever do–seems like a tug of war between two immovable objects.

The problem is that, as a society, we haven’t yet decided what we want our doctors to be.  We’ve moved away from the notion of the omniscient, God-like doctor, though overall it is still a profession defined by single-minded devotion, martyrdom, and sacrifice.  On the other hand, doctors are now viewed as more human and fallible than ever.  Television shows about doctors are perennially popular, though the current crop relish in the iconoclastic demolition of the Marcus Welby ideal of yesteryear; politicians and the public accuse us of greed, opportunism and carelessness in the face of skyrocketing healthcare costs; patients regularly challenge my clinical judgment by bringing in random snippets of often suspect information that they pulled off of Google.  I don’t begrudge any of this, as I believe idolism of any group of professionals is largely unhealthy.

But if doctors are people, why aren’t we allowed to act like we are?

The stressors of a life of medicine are well-documented, and such a discussion goes beyond the scope of this piece.  I will refer, however, to the fact that studies have consistently shown that medical students experience depression, burnout, and other mental illnesses at higher rates than their peers, and physicians have a higher rate of suicide than the general population-40% higher for male doctors, and an astonishing 130% higher for female physicians. One can discuss (and many have) the reasons for these differences, but having lived through med school and residency myself, I can tell you that while it is an incredible experience, the crushing expectations inherent in the culture of medicine render it an extremely dehumanizing experience as well.

We want our doctors to be perfect.  We want them to know all the answers, to never say the wrong thing, and above all, to always, always, be there for us.  We want our doctors to be superhuman.  But the fact of it is: they’re not. Doctors are not perfect, they’re not beyond mortal concerns.  After working 30 hours straight, they get tired, and that interferes with their ability to work well.  After being in the hospital for three weeks without a single day off, they get burned out.  When they get sick, sometimes it’s hard for them to come to work (though, to be honest, we are terrible hypocrites and most of us come in anyway).  They are young adults, and sometimes, they want to have connections outside of work–friends, spouses, children, and a reasonable amount of time to spend with them.  These are not ridiculous things to ask for.  These are not unthinkable standards to expect.

I’ve heard endless criticism about the values and work ethic of the current wave of young doctors (a recent catty favorite, in reference to many practitioner’s waning desire to work late into the night, was, “I guess doctors’ cars don’t have headlights anymore”), and while I can’t speak for every doctor in my generation, this much is true for my own experience.  I love the practice of medicine.  I love caring for my patients.  It is a vocation, and it is my passion.  Given the choice of whether or not to go into medicine, I would without a second’s hesitation do it all again.

But I want other things in my life too.  And I think that should be allowed.

Becoming a doctor requires hard work and sacrifice, but a system that expects their doctors to be committed to their jobs to the exclusion of all else is flawed.  And maybe there’s quite simply nothing wrong with young doctors at all, rather something wrong with the historical culture of medicine, such that the idea of doctors as human beings can inspire so much debate.

Michelle Au is an anesthesiologist and author of This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood. She blogs at This Won’t Hurt at Bit and the underwear drawer.  This article is reprinted with the author’s permission.

 

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  • Patricia Lindholm

    Thank you, Dr. Au, for so eloquently presenting the human reality of the medical profession. I have been in practice for 25 years after residency and have found myself broken on the shoals of the impossible standards that were inculcated in me during medical training. It took over 20 years for me to come to my senses, as you have done. I had three children during medical school and residency and wish that I could have had more time with them. The mythical heroic era of medicine is over.

    Our physicians should be well rounded people with personal experience of family life, culture and self-care. Only after caring for ourselves can we truly care about others.

  • John

    “The problem is that, as a society, we haven’t yet decided what we want our doctors to be.” This point is critical.

    As a current medical student, I don’t have first-hand experience of the personal and professional lifestyle of the previous generation of physicians as described in “More Doctors Say No …” and elsewhere. I hear and read that these physicians had near absolute respect and autonomy and that the rewards of the profession, both personal and financial, were great in comparison to the frustrations. The devotion and sacrifice expected is described as part of the deal. I don’t know which side flinched first, but respect, autonomy, and the rewards/frustration ratio seem to have declined concordantly with devotion and sacrifice. I also hear and read that things are, by almost all accounts, getting worse. Perhaps this means that the decline has not been as concordant as many physicians would prefer.

    This set of circumstances is not necessarily a total negative. A more healthy set of expectations, from all sides, is appropriate considering the cost of all that devotion and sacrifice. But, I can’t help but feel that much of the criticism levied towards physicians, as evidenced by the comments to the NY Times piece mentioned, is a result of patients wanting it both ways – all of the devotion and sacrifice, none of the respect, autonomy, or rewards.

  • http://www.thenerdynurse.com The Nerdy Nurse

    This is beautifully written and expresses the feelings of many healthcare providers. We do our very best and give of ourselves, but are we meant to be nothing else but doctors and nurses? Are we not meant to enjoy the pleasures in life that we work so hard to help our patients enjoy?
    To practice medicine requires compassion and humanity, and how does one expect for one to embody those values without being human themselves?
    Medical providers owe it to themselves and their patients to have healthy work life balances. It makes you a safer more efficient practitioner.
    Who wan’t a surgeon slicing on their bowels he can’t even hold his hands straight or his eyes open?
    Personally, I’ll take a physician who makes time for themselves, is well rested, passionate, happy, and eager to do the right thing because they want to and not because society says they have to.
    I want a human doctor.

  • debra

    Well said, thanks!

  • SidewaysShrink

    John is a keen observer of a change in practitioner’s approach to work/life that stems from the lifestyle choices Gen-Xers made in response to lack of opportunity and respect. We were the first cohort after the Baby Boomers to graduate with Bachelor’s degrees in the early 1990s which were worth nothing except a job at Starbucks. Such was born the generation of contractors, and job hoppers and the laid off. Knowing that each employer does not value you with any sense of security for you or that one’s role as physician in society is now not as respected but is suspected requires one to be indebted will give any sane individual pause. In this pause that individual will ask her or himself how much they are willing to sacrifice for a company or patients who will call and call and keep you on the phone all of your non-clinical hours if you let them…. It is good, this change, because I never wanted to play God anyways.

  • Penny

    This is a great article! My doctor is so overworked that he is starting to forget numerous things and is making many mistakes. This sets doctors up for lawsuits.

    Shortages are “deliberately” and “purposely” created by those in power. It’s the same thing in industry. They purposely and deliberately hire “just barely” enough staff to get the job done, and then expect their employees to come in running at every demand on their extra time at the first call. Why? Because they’re — gasp — desperate for the zillionth time — desperate “on purpose”.

    The more the employees cooperate, the more it will happen. The suckers who comply shouldn’t expect a promotion at any time either, even if they are lucky enough to receive a weak, forced thank you. Often their employers will simply see them as “desperate” themselves for having been sucker enough to come in time and again, and no employer feels a desperate employee will ever leave; thus there is no need to give such employees raises either.

    Furthermore, employees are called just enough times that they won’t “quite” qualify for for overtime. Should they qualify on rare occasions, they will continue to be called in until they are just a couple of hours short of qualifying for double time. Employers will always make sure they’re just an hour or two short of “any” reward whatsoever.

    You can’t keep chipping away at the bottom of the pyramid constantly without expecting the peak to come tumbling down suddenly one day with horrid and mighty force. Industrial greed is so rampant that this entire civilization is headed for a quick and sudden massive toppling and total wipe-out like the Roman empire.

  • T.McGraw.D.O.

    Your article is well written and true. I should like to add the word”happiness” to the comments. All living people ultimatelly achieve hsappiness via what they do. Our preparation permitted us to achieve this goal. As stated in the early part of your article,you learned acute care was your avenue. Let us as true professionals stop feeling guilty and practice medicine(caring for people) Thank you,T.McG.