A few months before COVID-19 swept the country, one of my surgical colleagues retired and his department arranged for a celebratory dinner, inviting people from the various eras of his life. There was an outpouring of response, and the large room was packed. Friends and co-workers gave speeches brimming with warmth, admiration, and love. Tributes were peppered with stories, inside jokes, and good-natured ribbing. There was laughter. There were more than a few tears.
My friend, without question, had a successful academic and clinical career. He had run a respected breast cancer program, built a busy, successful surgical practice, served as an associate dean, and was an advisor for a diverse group of students, residents, and junior faculty. People praised his academic and clinical achievements.
The evening’s focus, though, was not on his professional accomplishments. “He was the kindest doctor I ever worked with. All of his patients loved him!” said the nurse who worked alongside him for years. “He had strong opinions but was always a generous listener, no matter what. He made time for people,” said a friend from the community. “Everyone wanted to scrub with him or join him in clinic,” said a former resident. “When things looked most bleak, he comforted me,” said a patient.
At the end of the night, I thought to myself, “Everyone should finish their career this way. So why does this seem so incredibly unusual?” I don’t know the complete answer to that question, but I believe it has something to do with whether we stay true to our goals over the arc of our careers.
Medical students certainly start off in a good place. Many are drawn to medicine because they see it as a way of turning their idealism and altruism into a lifetime of service. More than once, I have asked a roomful of first-year medical students, “What motivates you to go into medicine?” and their responses are heartwarming. “I want to be a healer.” “I hope to accompany people through their difficult journeys.” “I pledge to concentrate my work on the forgotten and the underserved.” “I promise to be a great listener and take whatever time is needed to explain things to my patients.” “I will address social disparities, both here and abroad.” “I will bring healing and hope to all who suffer.” “I will give everyone my full attention.”
Yet, it won’t surprise anyone to discover that students evolve as they complete their residencies, graduate from fellowships, and go into practice.
Early in their clinical experiences, medical students explore how they might best separate their personal feelings from their “professional” responses to death and suffering. Their vicarious empathy — in other words, their innate ability to feel and respond to other people’s pain or suffering — drops during the first year of medical school and continues to decline throughout training. Students ask, “If I become emotionally attached to every patient, won’t my personal feelings overwhelm my ability to effectively practice medicine? I mean, if I break down while seeing the first patient of the morning, how will I get through the day? Surgeons can’t operate if they are crying, right?”
I tell them that it can be hard, but they should err toward caring and compassion. Empathy can be healing for both the patient and the physician, and our white coats are not designed to be used as shields.
Here is a thought exercise I share with them:
Recall the most engaging novel you read when you were in young. It was likely a book you stayed up late for so you could read “just one more chapter.” You could not put down. How did you feel while you were reading? Did the world around you drop away? Did you celebrate when the protagonist was ecstatic? Did you become outraged when they were treated unfairly? Were you anxious when they were in peril, and did you find yourself choking up when all seemed lost? After you read the final page, did you wonder what happened next?
As soon as you finished reading, I would bet you found a friend and told them the story. You made the characters come alive for your friend and, if you were moved, you promised to be a different person or change the world. Despite the emotional rollercoaster, the opportunity to accompany the protagonist throughout their quest made you a better person, right?
So, next, I ask the students:
Now think about a challenging or depressing clinical encounter. What underlying narrative makes the encounter difficult? Why shouldn’t we throw ourselves into our patients’ stories with the same level of attention, representation, and affiliation we brought to "Harry Potter," "Little Women," "The Hobbit," or "Anne of Green Gables"? If we were willing to invest our emotional selves in the stories of fictional characters, why are we so hesitant to do the same for the people who are suffering and in peril right in front of us? Why do empathic relationships seem so dangerous when it comes to patient care?
There are ways to help stay on track. I run sessions with residents where I ask them to remember and refocus on their original motivations and goals. We imagine what colleagues 35 or 40 years from now will list as their most enduring qualities. Current residents see retirement as very far off, yet even they recognize that they have changed since starting their journeys. If their deeply held beliefs have transformed this much in the first decade of their careers, in how many more ways might they evolve in the future?
As they anticipate the end of their careers, my residents hope they will be admired for their compassion, generosity, teamwork, and humility instead of their RVU generation, income, or make of car. They dream that they will draw satisfaction from being part of effective, caring teams that provide quality care in times of great need. That, to me, sounds a lot like a first-year medical student's answer.
Physicians are human beings who have been blessed to possess a slightly enhanced knowledge of physiology, pharmacology, and related scientific fields. At some point in each of our lives, we felt called to care for those who are suffering. Like it or not, we also serve as role models for those who come behind us. Rather than showing our younger colleagues how best to build “professional moats” around our physician personas, perhaps we should tend to ourselves and build some bridges.
In "Just Mercy," Bryan Stevenson writes, “we can embrace our humanness, which means embracing our broken natures and the compassion that remains our best hope for healing. Or we can deny our brokenness, forswear compassion and, as a result, deny our own humanity.”
On many of the 14,600 days of our career, things seem fine, and we keep plugging along. Yet, we remain broken and imperfect. Denying our brokenness hardens us in our personal and professional relationships. We owe it to others to rekindle what brought us into medicine in the first place. We will be better equipped to share what we learn with the people with whom we spend our days and with those who trust us to care. Returning to our ideological roots might reinvigorate our passion and joy. Retirement will come soon enough.
If someone who didn't know you watched you at work for a week, would they be able to discern why you decided to become a physician? What would they think motivates you? Share in the comments.
Bruce H Campbell, MD FACS is a head and neck cancer surgeon at the Medical College of Wisconsin. His book of essays, A Fullness of Uncertain Significance: Stories of Surgery, Clarity, & Grace (Ten16 Press), was published in 2021. He blogs at BruceCampbellMD.com. Dr. Campbell is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz