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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