I want to talk about dehumanization in medicine. And, yes, part of this discussion is about our patients. But another part — just as important — is about the dehumanization of us, the doctors.
Most of us have had that moment in the third year of medical school when we are sitting in a mandatory reflection session, and someone brings up the erasure of our patients’ identities. This is true, and it’s important. Our patients are turned into room numbers and diagnoses, and we don’t have to think about how “Room 305, AML” is a history teacher, father, and avid rock climber. We spare an hour to talk about empathy and human connections, and then we go back to our library stalls and six a.m. pre-round scrambling.
I don’t want to discount the value of reflecting on our patients’ humanity. We would not have chosen this profession if we did not care about people, independent of their lab numbers and CT scans.
But I think it’s time to talk about our own erasure.
We all know the statistics on physician suicide. Doctors are more than twice as likely to kill themselves as the general population, and the relative risk is even more pronounced for women. We can point to a number of contributing causes: doctors are notorious perfectionists, we are tired, we are traumatized by our patients’ suffering. We are lonely and stressed and fighting through an ever-growing mountain of administrative tasks. Running through all of these stressors is a common theme: it is too easy to lose our own identities as people outside of medicine. It begins early in training, and it does not stop.
Physician-patient interactions are, necessarily, focused on the patient. Patients tell us about their fears and their tragedies and their triumphs, and in return for their trust, we offer our listening and our expertise. There is absolutely joy to be found in these connections. But there is also a certain amount of personal censorship, as we sometimes must hide our own values to serve as nonjudgmental healers. When I have a homophobic elderly man rant about the degradation of American values while trusting me to manage his heart health, I do not tell him about my wife. I talk to him about exercise and his medications, and I always wish him the best when he leaves the office. And I have lost count of my friends and colleagues who have quietly sidestepped racist and sexist remarks through the course of their careers.
I think most of us enter medicine with the expectation that we will always prioritize patient care, regardless of personal differences. It is hard to predict, however, the extent to which our personal censorship will extend beyond these patient interactions. As trainees, we are so reliant on the evaluations of our upper-levels that we rarely express different opinions. I learned early on in medical school that my academic success relied on maintaining polite enthusiasm. Hospitals are built on a hierarchy of power, and it is difficult to challenge that hierarchy without simultaneously challenging our own professional prospects.
When I was a third-year medical student, I stood quietly in the OR as two attending neurosurgeons discussed the reasons that they hated women in power.
“All women are weird or crazy,” said one.
“It’s always one or the other,” said the other attending. I said nothing. And I said nothing when another attending addressed every woman in the room as “pumpkin” or “darling,” ignoring outstretched hands to pat us condescendingly on the shoulder instead of the expected handshake. I was an adult and in an incredibly privileged position — and yet, I felt invisible.
When I started internship, one of the senior attendings gave us a talk (or perhaps a scolding). “You are doctors now,” he said. “You don’t get holidays. Your first responsibility is to your patients and your team.” He made a single exception to that rule: “If you have families, we also want to support you in caring for your spouses and children.”
Too often, our worth as physicians is defined solely by our ability to care for other people. I do not regret my career path, and I continue to find joy in my role as a physician. But where do we turn to decompress — to be ourselves — when our schedules turn us into exhausted note-writing machines?
To those who say that young doctors should be more resilient, I ask this: How many deaths does it take? How many times do we need to read another article or text from a friend that yet another promising doctor lost their life? How much more — before we start making real systemic changes?
I don’t have all the solutions, but I know that we need top-down efforts to protect our humanity, both during and after training. We need fewer classes that place the responsibility for resilience on those with the least autonomy. We need more discussions on eliminating redundancies, with real evidence-based strategies to streamline training in order to protect both learning and our time. And there need to be real repercussions when physicians in power ascribe to outdated, prejudiced views that are toxic to those training under them.
Let’s talk about our humanity outside of medicine. Lives depend on it.
Hannah Dee is a physician.
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