We’re Doctors, Not Martyrs | MedPage Today

It’s not like someone forced you to go into medicine. If you don’t like it, leave.

Doctors are only in it for the money, or they’d treat people for free.

Our patients can be violent, and that’s just part of the job. You chose this.

Do these opinions sound familiar? And if so, what emotions come up? Frustration? Resignation? Helpless rage? All are understandable; these common sentiments about doctors’ obligations range from entitled to outright dehumanizing, presuming doctors owe medicine unqualified servility.

It’s an attitude that I’ve encountered in medical school and (mercifully rarely!) amongst my own patients. One was furious with me for daring to take a vacation, despite the fact that my highly reliable colleagues were covering in my absence, and that the patient wasn’t scheduled with me until after my return anyway. That knowledge was apparently unsatisfactory:

“But what if I need you? I’m not comfortable with you leaving. Where are you going?”

“I’m afraid that’s personal.” A weeks-long tantrum ensued, lasting well after I came back, involving tears, vague threats, and dramatic splitting.

Yes, healthcare workers should be held to higher standards of academic excellence, ethics, and professionalism than the average person. Yes, we need better distress tolerance than most. But this doesn’t mean we owe medicine our entire lives.

Doctors Can Be Parents

Recent verdicts favoring the plaintiffs of two pregnancy discrimination cases decidedly signaled the shift in public understanding of what doctors owe medicine. A Michigan jury awarded Nicole Walker, DO, $10 million after she was fired during maternity leave from her former OB residency at Ascension Genesys Hospital (now Henry Ford Genesys Hospital), while a Texas jury awarded Andrea Avellan, DO, $4.4 million for similarly discriminatory behaviors during her internal medicine residency with Methodist Hospitals of Dallas.

Women in medicine disproportionately face barriers to professional advancement and the unendingly frustrating gender pay gap, driven in large part by the still-pervasive myth that a mother in medicine is insufficiently devoted to or incapable of optimal patient care. You can imagine the difficult position this puts women in, especially in today’s America, when misogynistic malcontents seem hell-bent on pushing women out of medicine or commodifying women’s bodies under the cover of “societal good,” furthering the false narrative that motherhood and medicine are incompatible.

But given data showing the superiority of patient outcomes under female physicians, the perspective that a physician is insufficiently dedicated if she is a mother collapses, exposed for its biased absurdity. Wanting a family is normal and doctors shouldn’t have to sacrifice it to prove their devotion.

The Price of Medicine

A recent date scoffed at my frugality (an important value to me, painstakingly cultivated by my father, who grew up in poverty): “You’re a doctor, you’re rich” (I’m a resident, I’m not). He proceeded to ramble about exorbitant physician pay. I pretended a friend was having an emergency and escaped the date shortly thereafter.

This wasn’t the first time I’d heard someone not in medicine opine rudely about physician compensation. The underlying assumption is that doctors shouldn’t care about reimbursement, if they are truly dedicated to their patients.

Discussing money in a caring profession may seem crass, and our training reflects our hesitancy to do so; medical students and residents receive notoriously little financial education. But this viewpoint disregards doctors’ vast investment of time and money in their training. The average medical school graduate carries over $200,000 in student debt and merely being in school costs years of income-earning potential. Tuition aside, the costs of applying to medical school, studying for and taking the boards, and applying to residency add up quickly. Resident/fellow salaries are decidedly below the oft-derided “rich attending” salaries. Physician salaries comprise 8.6% of national healthcare spending, and disproportionate public focus on our pay misrepresents us as avaricious predators seeking to capitalize on our patients’ vulnerability, ignoring the realities of what we give to medicine and our own needs.

Furthermore, we make profound personal sacrifices just to become doctors. My colleagues and I have missed holidays, weddings, funerals, and more, and have delayed life milestones in pursuit of our education. Doctors can be many negative things: “type A,” narcissistic, rigid, short-fused. But most of us cannot be credibly accused of lacking dedication.

No One Signs Up for Violence

This commentary would be incomplete without discussion of rising violence against healthcare workers, who are five times more likely than others to suffer a workplace violence injury. Recently, one of my favorite attendings was brutally beaten by a patient, landing in the emergency department and needing time off to recover physically and psychologically.

The total annual cost to hospitals of workplace and community violence exceeds $18 billion, if the moral argument to curb violence — including against clinicians — was insufficiently convincing. Unfortunately, many violent events go unreported, and healthcare workers often feel insufficiently supported by their administrations and occasionally, even by their colleagues.

No one is functioning at their best if they need to be in a hospital, and we understand how fear, paranoia, altered mental status, or frustration can drive someone to lash out. Deescalation training for doctors and nurses is therefore critical; but sometimes, deescalation is ineffective, and we need to reach for more restrictive measures. Intramuscular agents, seclusion, or physical restraints are not uncommon in psychiatry, for example, and can be lifesaving not only for providers, but also for other patients and their loved ones in the milieu.

Yet, doctors’ devotion to patient care may be challenged if they support restrictive measures for safety maintenance. Using restraints on a patient is morally distressing (which is healthy — you should never feel too comfortable tying anyone down), but sometimes necessary. A naïve willingness to tolerate violence against healthcare workers could get someone seriously injured or killed.

There’s a reason why a particular episode of “The Pitt” resonated with so many viewers: Dana, a nurse who had been assaulted by a patient in a previous episode, reactively subdues another patient holding a young nurse in a chokehold with a sneaky vial of midazolam (Versed). Her actions — which I understand, but do not condone — reflect the reality of hospital violence that is often not addressed meaningfully. Although we voluntarily witness patients or their families’ worst moments firsthand, we certainly do not owe anyone our physical safety. We didn’t sign up for that.

A Plea for Understanding

Compassion for patients does not necessitate absorbing cruelty in silent compliance. Nor does it require unconditional surrender of our entire selves. Boundaries are healthy. Fulfilled, content physicians who can hold identities outside medicine — as parents, writers, foodies, artists, athletes, and more — are optimal physicians to vulnerable patients.

I would hope that our patients can have the compassion for us that we hold daily for our communities. And more importantly, I hope you, dear physician reader, can hold that compassion for yourself.

Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York. The views above reflect only the author’s and are not shared or endorsed by any institution with which she is affiliated.