I recently listed to a series called Shame in Medicine that was published in the podcast The Nocturnists. If you work in medicine (whether a doctor or another type of provider), it is definitely work checking it out. It really got me thinking about how we are taught from the undergraduate pre-med courses to the whole path we follow until we become attending physicians. It reminded me of so many things that I wish had been done differently.
Shame in medicine takes on so many forms and sometimes it’s hard to recognize. The most important takeaway for me from the podcast series was that we expect people who are human and make mistakes to be perfect all the time and realizing now how impossible this premise is. Often, these demands are made of people who have not been drinking water, eating enough calories, or sleeping. When you think about it, it sounds crazy that this is how things are but yet, the culture in medicine is slow to change.
As I now get close to being “mid-career” (or so I am told), I started mentoring more medical students and residents. I want to be part of the change in culture in our profession and working with trainees has been a great way to do so. I don’t want this blog post to be about all the things that are wrong with medicine but I wanted to highlight some areas that need major improvement and some ideas I have to make things better.
- Impostor syndrome. I had never heard of this concept until I was 4-5 years into my training after medical school. I had definitely experienced it but didn’t know it had a name. If you are not familiar with this concept, it is basically feeling like you are not in the right place and that somehow you will be found out and sent packing. Shame is a huge part of this feeling. Many people experience this but in medicine, we also know that minorities are more likely to feel like they don’t deserve to be where they are and that at any moment someone will realize this and ask them to leave. I try to be very open about this concept. I love to tell my trainees that they are exactly where they need to be. I think it is also very important to normalize this feeling. It is ok to have the feeling, recognize it, but also notice that it is not who you are and that you can move past it.
- Expecting perfection. Many people that go into medicine spent their entire life getting straight As, being the best at everything, and easily (or not so easily) achieving all their goals. Once you put all these people together, things get complicated. As I mentioned earlier, perfection is expected from people who are human and will make mistakes. While personal responsibility is important, acknowledging that it is ok to not know things is key in medicine. I start all my courses and rotations with medical students by telling them that I don’t expect them to know how to do the things they are here to learn and that this is ok. There is a lot of shame around saying we don’t know something in medicine and moving away from expecting perfection is one way of improving this attitude.
- Being a martyr. I don’t know where this one came from but since medical school, there was always an attitude of having to sacrifice in order to be better. Sleep less, eat less, work more, study more. Telling someone you have to leave early for an appointment or to pick up your child feels shameful, even though it is real life. We understand this in other people but for some reason not us. I now tell all my residents that they never need to ask me if they can go to the bathroom/drink water/eat something considering these are basic human needs. Residency is definitely a time where one works hard but it doesn’t mean that food, drink, and sleep have to be sacrificed. There is a big push for “wellness” in medicine but if we don’t start with the basics, that hospital wide 5 minute meditation is not going to be super helpful.
This is only the beginning for me in trying to help change the culture in medicine. From the podcast series, I can tell that there are many other physicians and providers working on improving things. Many hospitals and medical schools are already trying as well. More and more classes and standardized tests have become pass/fail. I hope that those of you reading that work in medicine will join me in this cause and also help change our culture, one person at a time. I would love to hear your ideas!
