Is authenticity a luxury in medicine?

As physicians-in-training, medical students suppress feelings and mask them under the veil of professionalism. Sometimes however, medical training requires us to manufacture emotions. During the third year of medical school, the majority of student grades are derived from the subjective evaluations of the residents and attendings that work with us. To achieve the highest marks, students must appear to be “engaged” and “excited” at all times. While most of us are genuinely interested in helping our patients, I’ve come to believe that putting that passion on display is a perversion of that passion.

Clinical faculty recognize that students will have natural affinities for certain areas of medicine over others, but as we rotate through the core specialties, they encourage us to savor each opportunity to engage in patient care as if was our last. Adopting this attitude has not only heightened my clinical exposure, but also allowed me to develop deeper relationships with some of my patients. Medicine is truly amazing. I recognize that I’ve been blessed with the invaluable privilege of witnessing humanity through this unique lense. I fear, though, that some of this engagement has been inauthentic and shaped by the unique pressure of impressing my teachers.

Last year I helped care for a patient every day for nearly two weeks.

My patient and I quickly discovered our common ground. We grew closer and bonded over our shared love of cooking and celebrity gossip. In between my physical exams, we exchanged recipes and I helped spice up her lengthy visits to the dialysis unit by bringing her the copies of US Weekly magazine that I didn’t have time to read.

On the morning she was discharged, my patient spotted me in the hallway while I was rounding with my team. She interrupted the group to give me a huge hug. She thanked me for my time and attention and wished me the best in my future studies. I was genuinely happy that she received the treatment she needed and hoped the plan implemented by the medical team would help her to better manage her chronic conditions. My second thought, however, was how serendipitous it was that this interaction occurred in front of my attending and residents.

Awesome! I thought. Now it will be obvious to everyone that my patients love me. This thought was quickly followed by disgust and remorse. Who am I? Who am I becoming? While medicine is teaching me how to care for my patients, is my medical education teaching me to exploit these interpersonal interactions for personal gain?

A few years ago, one of my friends graduated from medical school with many awards and clinical distinctions. I asked him if he truly loved every rotation, and he replied, “No, I didn’t love most of it, but I did exceptionally well because I knew how to play the game.” While proto-millennials like Lena Dunham revere authenticity, I’m not sure the medical students of this (or any) generation have the same luxury.

Among medical students, the “game” is not a secret. Before I started my third year of medical school I reached out to a few senior students and asked them about the most challenging aspects of third year:

“It’s exhausting smiling and being ON all the time,” said one student. “Faking excitement is both stressful and draining,” explained another.

By the end of my third year clinical rotations, these are sentiments I felt more often than I’m comfortable to admit.

According to Annie Murphy Paul, surface acting, or “having to act in a way that’s at odds with how one really feels … violates the human need for a sense of authenticity.”

In an article called, “The High Cost Of Acting Happy,” she explains the effect of surface acting on the human psyche. “This kind of faking is hard work,” she writes. “Sociologists call it ‘emotional labor’ — and research shows that it’s often experienced as stressful. It’s psychologically and even physically draining; it can lead to lowered motivation and engagement with work, and ultimately to job burnout.”

Many medical students feel jaded by the end of their core clinical year. Could surface acting be contributing to the erosion of their genuine enthusiasm and dedication to patient care? Is there any way to protect students from the pressures to perform their passions? Is authenticity a luxury in this profession?

Jennifer Adaeze Anyaegbunam is a medical student who blogs at her self-titled site, Jennifer Adaeze AnyaegbunamShe can be reached on Twitter @JenniferAdaeze.  This article originally appeared in The American Resident Project.

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  • SteveCaley

    The entire American business environment seems to be predicated on teh
    manufacture of the False Self. Schools reward students for looking like
    they learn; and later on, for looking like they enjoy what they are
    doing on rounds. It is convenient, if genuine; but it is punished, if
    it is not convincingly mimicked. Why?

  • Dave

    My experience was that the people who were jaded by the end of clinical year were the same ones who were jaded by the end of preclinicals.
    The truth is that some days we all have to do more acting and fake passion and enthusiasm, but many or most days it’s just naturally how we feel. If someone is having to fake it every single day, that person should probably find a non-clinical specialty.
    Your reaction when your patient hugged you in front of everyone is absolutely natural and in no way perverts the beauty of the moment. You’re a human being – it’s normal to feel that way.

  • ninguem

    Authenticity.

    If you can fake it, you’ve got it made.

  • Dr. Cap

    Welcome to the world, dear. Do you think that thirty patients will pack up and go home because you just don’t have it that day? Applies to every other Real Job out there. The ones that require human interaction anyway.

    Speaking as a clerkship director, I can also call hooey on much of the premise. Students who get Honors are not necessarily kiss ups or falsely enthusiastic. They are the ones who ask to present topics at rounds, who, while holding the camera in a lap chole, can talk intelligently about gallbladder cancer or basic tenets of dealing with an intraop bile duct injury. It has nothing to do with sunny dispositions. It has to do with knowing what you’re talking about.

  • http://www.esseinstitute.com drseno

    Being tolerant, having an open mind at all times on all subjects is being authentic (Heidegger and others). And when you are being that way, you will win and so will those with whom you are engaging. It’s like our best friend, the dog who does this amazing thing in just existing, being tolerant and open and making our lives better just by being ‘for’ us. We can be that way by practicing it. It won’t matter where and why it’s ‘expected’ of you if you just set an intention to be that way as much as possible; because it’s good for you and good for everyone else. And don’t beat yourself up for being happy that your success in being authentic with patients showed up on display at the right time. That’s cool and you earned it by actually *being* it. It was natural. Do more of that. How does it get any better than that?

  • Doug Capra

    Those who think they’re successfully “playing the game” need to reevaluate. We all have a sixth sense to identify inauthenticity. We often can’t quantify the sense, but it’s there. Most of what we think we’re communicating, may not be happening. Words? They play only a small role. We really communicate with our body language and our vocal tone. Scripting is an example of potential inauthenticity. People can tell right away whether a script is a script or whether it comes from the heart. Don’t kid yourself. To really “play the game” successfully you need to be an exceptional actor, and most of us are not even though we may think we are. Faking it is not “just hard to do” and it’s not just emotional draining — it’s really impossible for most of us. We may “feel” that our faking appears real — but that’s not how most people read it deep down. They often won’t say anything or complain. But they know. They may even fake that they really believe you. Then both of you can stand there as the elephant walks across the room. Unless you’re a talented actor or a talented psychopath or sociopath — be wary of believing that “playing the game” isn’t interpreted by others as exactly what it is — “playing the game.” All this doesn’t only apply to medical professionals, of course. It applies to all of us.

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