Are we training a generation of soft doctors?


I watch as my almost-2-year-old daughter awkwardly climbs the stairs. I do not hold her hand, but I do not turn my back on her either. She is still clumsy, and her little-bowed legs often miss their targeted landing spots. She holds on to the rail with a vice grip that steadies each monumental step forward and upward.

Every so often she wobbles as she miscalculates the distances and her toes barely catch the edge of the next step. Her knuckles become white as she reorients herself, recalculates her next move, and ensures she does not tumble backwards. My palms sweat and my muscles tense during every mishap and sway — I want her to get to the top — but just as importantly, I want her to do it herself.

After she regains her composure from a mini-spill, I cheer, “Good girl!” I am close enough to catch her if she falls all the way down but not close enough that she can use me as a crutch to get where she needs to go. I think she senses this, and it gives her just enough confidence to keep going. Every fiber in me wants to get up and carry her the rest of the way, but I know the consequences down the road: She will always expect me to do it for her. She will cry and whine and, when it gets too hard, good old Baba will come to the rescue and move her to safety.  She gets to the top and turns to look at me.  I consciously look away as if I wasn’t watching her every move. “Baba … up!” The grin on her face makes me fall apart, and I run up the stairs and tickle her until she cannot breathe.

This is an everyday occurrence with her.  Sometimes she fails and cries and looks up at me with her big green eyes begging for a hand to Providence (at which point I melt like any man would and give in to her tiny wishes) and other times, she gets back up by herself and tries again … and gets the job done.

I want her to be safe, but I do not want her to be “soft.”  This is the dilemma that most physicians in the academic realm struggle with every day in training the new generation of doctors. Psychology Today recently published an article that discussed what seems like an epidemic of individuals in college who are unable to cope with even the simplest unavoidable day-to-day adversities.

Although the article dismisses the fact that, historically, most psychosocial troubles that students faced were undiagnosed and swept under the rug and that the increase in numbers of those seeking help may just represent a generational recognition of the needs for those services, it still surfaces a serious concern.  Many people in teaching/training positions in the medical academic realm believe that many medical students and residents lack resilience and self-sufficiency.

With much discussion focusing on how to decrease burnout, increase physician (and docs in training) access to psych support, and better resident well-being, are we in danger of going too far the other way? Are we setting ourselves up for a generation of soft doctors who lack the ability to handle the stress of an occupation defined by its intensity? Internists come face to face with mortality, familial strife, and enormous amounts of emotional distress, all while being expected to remain calm, cool, collected, and objective. The reality is, it’s the physician who is expected to carry the brunt of the stress and mold plans of action for multiple patients every day. Can a soft doctor handle that level of responsibility? Should a doctor handle that responsibility?

Then the question becomes: How do we turn out quality physicians who are armed with the tools (knowledge, skill, and personal fortitude) from training systems in which the major concern is preventing burnout? This question is difficult, and the process will alienate many as being ill-equipped to handle the job.

Finding the balance between developing physicians with the capabilities needed to handle the realities of the job and not burning out a large portion of them before they even get so see a patient autonomously must be the focus of those who control the avenues of training.

I do not have a good answer for this question — both endeavors are extremely vital for the future of medicine. Perhaps the answer can be found somewhere in the tale of how a parent deals with his or her child climbing the stairs: letting them take risks, experience the consequences, know the taste of failure, encourage persistence, and celebrate eventual success.  All I can say for certain is that the best part of parenting is when you get to celebrate with them when they’ve reached the top.

Ahmad Yousaf is an internal medicine physician who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

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