Where has the loyalty in medicine gone?

There are 168 hours in a week and 8,736 hours in a year. There are 10,080 minutes in a week, and 524,160 minutes in a year. Residents and fellows working in an academic environment often work close to, if not in large part, more than 80 hours a week, or 4,160 hours a year. They work 4,800 minutes a week, and a staggering 249,600 minutes a year. In medicine, it’s simple, be perfect all 4,800 minutes a week and all 249,600 minutes a year. Decisions made in 30 seconds, arguments that last two minutes and moments out of character for less than 0.001 percent of your work week ultimately dictate how reprimanded you will be, how damaged your reputation is and, ultimately, how you feel about your self-worth. That is the reality of medicine. And it is a lonely feeling.

Department chairs, fellowship directors, and residency program leaders seem to care little about the other 249,598 minutes of your year, they care about the two minutes of frustration you expressed after a long day of work serving others with little help and even less emotional support. Where do we turn? It takes pieces of you. At first, they’re so small, you don’t notice until you wake up one morning, and you don’t feel like yourself. You don’t feel like the person you started out as, the person who worked hard to be there, the person that comes home fulfilled and, ultimately, a person.

I remember a specific incident, letting off steam in the resident workroom with some co-residents after a long day of work. Unbeknownst to me, an attending happened to be in the room, was offended by the comments I made, and immediately told my program director. One month later, I found myself in the hot seat being reprimanded by someone who has said the same, if not worse, things during our daily morning conferences. And again there is that feeling, that pit in your stomach that you are all alone. That others who have lived in your shoes and endured the trials and tribulations of residency and fellowship — that are the supposed mentors of their juniors, once again only speaking to you when you have done something wrong and never lifting you up for the other 4,798 minutes you have succeeded.

Where has the loyalty gone? Where has the support gone? It is this cold, harsh reality of medicine that undoubtedly has played some role in the high number of physician suicides and in the ultimate low morale of medical professionals. When even those that have experienced what you have turn the cold shoulder, who else is there to turn to? Who else can sympathize?

I am writing this not to complain or to lay blame on any single individual, but rather to shed light on a certain, often covered up, aspect of medicine. This, if anything, is a plea to those who hold leadership positions. Residency and fellowship are difficult, and the hours, minutes and seconds immense. Instead of scolding people for seconds out of character, support them, ask them what you can do to help them and ultimately, be loyal. This is, after all, a team sport, and we are all here to do our best, even if our best isn’t always what shows up.

The author is an anonymous physician.

Image credit: Shutterstock.com

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