Remember your humanity, and forget the rest.
-The Russell-Einstein Manifesto
The American healthcare system is a paradox of triumph and failure. We lead the world in medical innovation, yet we lag behind in cost, quality, and equity. During my last month of medical school, I sat with a group of graduating students to discuss this challenge. As students, we had directly confronted the shortcomings of modern healthcare. As the next generation of physicians, would we do better? Could we do better?
The group consisted of several accomplished individuals, each destined to be a leader in medicine. Nine specialties were represented, ranging from family practice to neurosurgery. The conversation was insightful and impassioned, but there was an underlying tone of caution. We used delicate language, exchanging glances of a mutual understanding. Eventually, someone noted what we all were thinking. The discussion was starkly different from what it would have been if we were first year medical students. We had changed.
Of course we had changed.
As first years, we were brazen and quixotic. We were more than ready to throw away the status quo and succeed where our predecessors had failed. Now, as newly minted physicians, we were utterly, almost nauseatingly, realistic. The naivety of inexperience had been stripped from us, and buried in that conversation was an unsettling seed of cynicism. Although we hoped for success, we were quick to list the ways that our efforts might fall short. Our words were soaked with the pragmatism that had been bludgeoned into us (perhaps by necessity) during two years of clinical training.
The clinical years of medical school are infamous for transforming happy students into bitter physicians. The pre-clinical years that precede them are often referred to as the “pre-cynical” years. In one large survey, 50% of students reported feeling burned out, and 11% reported suicidal ideations. Those who make it through medical school with their enthusiasm, hope, and humanism still intact are not home free. The same experiences that serve to erode such characteristics are encountered day in and day out for the rest of one’s career.
In just two years, my classmates and I went from having our heads in the clouds to being irreversibly grounded. How will we change after another two years? Ten years? Twenty? I am forced to ask a scary question. Which of us will eventually succumb to the ugly reality of medical training? Could it be me?
I used to think that I was immune to cynicism. I am a hopeless optimist who has been accused of being “annoyingly positive.” While some debate whether the cup is half full or half empty, I respond, “I can’t believe I have a cup! Cups are awesome!” How could anyone with this outlook ever become jaded?
I now understand that my positive attitude is not a shield. I am not special. No physician begins his or her career planning to become despondent. The process is insidious, and we are all at risk. It is hard for me to admit that fact. To concede my own susceptibility feels like a step towards defeat. Certainly, it is more comforting to pretend that I am impervious. But no challenge is overcome by seeking comfort. In fact, we should relish in the discomfort that we feel when we confront our weaknesses.
Indeed, our vulnerabilities are a deeply meaningful aspect of our humanity, and nothing is more important to the practice of medicine than humanity. Unfortunately, it is easy to lose sight of this fact. In the setting of modern healthcare, physicians are made to feel like mere cogs in a machine. We spend more time with paperwork than with people. We are pressured to be efficient and pragmatic. On a daily basis, our best is not good enough, and it often feels like the system is working against us. Inevitably, we have moments of exasperation and discontent. In the instant when we feel disempowered, cynicism creeps upon us.
Instead of hiding these feelings, we should accept them as valid, reflect upon them, and remind ourselves of our fallibility, our humanity. If we approach our patients, not as a physician approaching disease, but as one human caring for another, the frustrations of our medical system melt into the background. As humans caring for one another, there is always hope that we can do something good and meaningful. We are never disempowered. Perhaps that which we wish to protect — our humanity — is best preserved when left exposed and vulnerable.