The Toll Medicine Takes

It’s not you, it’s medicine.

Beneath the white coats and calm demeanors, many medical professionals are grappling with their own mental health. The demands of a life in medicine can take an unexpectedly heavy toll, leading to among other things, emotional exhaustion, burnout, moral injury, a loss of self, self-medication, anxiety, depression, and a break-down of your most important relationships. But before we cast any judgement, let’s take a closer look at medicine through a systemic lens and its impact on the people that are subject to that system. It’s impossible to understand anyone until you understand them in context. And, if you are a medical professional, this applies to you. Medicine is a system, a context, one with norms, power dynamics and dysfunction.

How did it end up like this?

No one warned you when you started training that this is what a life in medicine would really look like. You may have seen burn-out in the eyes of your mentors, but thought that surely was never going to be you. A desire to help others and the promise of a better life after may have fueled your optimism. A life with autonomy, agency, balance, and financial stability, just to name a few. But for many, those promises never came to pass. In the world of profit-driven medicine, medicine is less about the ideals that drew you to this field and more about someone else’s bottom line above all else. And now, here you are, highly trained, perhaps deeply in debt, with seemingly no other options. You may even find yourself being required to train less qualified providers to eventually replace you.

The Gauntlet of Invisible Pressures

Physicians are constantly under immense pressure. From making life-and-death decisions with no room for error, to the near inevitability of being sued, to irrelevant patient questionnaires being used to judge your competence, to your inability to take a sick day and care for yourself. Not to mention, being subjected over and over again to traumatic and emotionally taxing situations with no substantial resources to deal with them and the fear that if you do seek help, you will be pathologized or face serious consequences. Frequent exposure to suffering, death, and the emotional pain of patients and their families very understandably and predictably can lead to traumatic stress - the burden of patient care can become overwhelming. With scolding platitudes to take better care of yourself and no meaningful support, the detrimental mental health effects of medicine on those within the system are a very predictable outcome.

Cultural Norms

The culture of medicine has long perpetuated stoicism and self-sacrifice as virtuous, an idealized but in fact pathological norm robbing medical professionals of their humanity. Labeling vulnerability, expression of emotions and needs as signs of weakness, medical providers are shamed into falling in line. In an attempt to prove to a very disapproving system that you are in fact worthy, many attempt to meet unrealistic and unsustainable productivity expectations, push through their own exhaustion, prioritize their patients and suppress their most basic human needs. While the medical system labels the aforementioned as “necessary,” it is to the extreme detriment to the healers themselves.

The Fallout

With some variability between specialties, the system of medicine negatively impacts the mental health of those in it. The perception that medical providers are overtly empowered paints a false narrative of autonomy and agency that is in fact juxtaposed by the fact that they are covertly disempowered, having little control. They are subjects to a dysfunctional system. This false overt empowerment shifts the blame squarely to the people harmed by the system, deflecting from the harmful and exploitative system itself. Unhealthy systems maintain power and perpetuate by convincing their victims that they are at fault - clearly, there must be something wrong with you.

A Path To Healing

With greater clarity, you can mindfully and intentionally take steps to address the things that are within your control and stop internalizing what is outside of your control. The first step is detangling yourself from the myths perpetuated by the dysfunctional system. It is not you, it is the system. Caring for your basic needs, including your mental and physical health are no longer optional. Healing from the effects of medicine is a very personal process for each medical professional and may involve therapy, peer mentorship, spiritual mentorship, career coaching or a variety of other resources to help you reconnect with and live a life aligned with your authentic self. Healing is absolutely possible!