“I wish I wasn’t a doctor. I wish I wasn’t terrified at what I may be asked to do. I wish I could self isolate,” Dr. Rebecca Lawrence, a consultant psychiatrist in addiction in Edinburgh, Scotland, wrote on Twitter last weekend.
As physicians ourselves, we find Lawrence’s sentiments understandable, her worries heartbreaking. All of it is tangible and real in the face of a pandemic that has already cost the lives of many health care workers, and poised to take even more.
But what is perhaps the most telling about her tweet is that she prefaced her comments by saying, “I’m going to say something unpopular,” and then ended it with an apology. It’s as though she felt like she should not, as a physician, express fear about this pandemic. She had to be a good doctor, stepping up to take care of others, without doubting her role and questioning the risk. It is as if she believed that physicians cannot be both heroes and human.
I’m going to say something unpopular— Rebecca Lawrence T (@Rebecca99LT) March 28, 2020
I wish I wasn’t a doctor
I wish I wasn’t terrified at what I may be asked to do
I wish I could self isolate
This is a struggle we deal with daily. Just like everyone else, we have difficulties processing the new post-pandemic reality. We want to stand up for our colleagues to make sure those on the frontlines have the equipment they need to protect themselves, but doctors’ voices are being silenced all over the country. Hospital workers in New York are being told not to talk to the media, and some are being fired for questioning the safety of the personal protective equipment they are provided. This relays the message that our fears and concerns don’t really matter.
Meanwhile, we have anger, sadness, fear, and anxiety, immense feelings that seem to come out of nowhere, like a tidal wave, and scare us. We choke them down to just do our jobs. Because that is what doctors are supposed to do.
Most physicians are trained to put patients first. That ethos is drilled into us from the time we start medical school. Indeed, we have forsaken ourselves so frequently and for so long that the medical workforce suffers from burnout at higher rates than many other professions. And, while 80 percent of physicians say practicing self-care is “very important” to them, barely more than half of them practice it often. In other words, we do not practice what we preach.
This is especially the case with emotional expression. While patients have said they would be open to, or even appreciate seeing a physician cry, most physicians do not cry in front of patients and view it as inappropriate, unprofessional, or weak. For many, medical training is associated with a loss of empathy related to the immense distress and burnout trainees experience.
Physicians’ interest in the lives of our patients and connecting with them emotionally wanes over the course of our training as we are exposed to more trauma and role models that seem to pride themselves on their lack of emotion. Although there have been more conversations in recent years around how physicians cope with death and dying, expressing emotion is still not commonplace or expected.
Now add the stresses of a pandemic. Just imagine you are a physician right now. Your training taught you to put patients first and to show no emotions. You did that. But now you are under even more pressure than you ever thought you would experience. You are practicing medicine without adequate personal protective equipment to keep you from getting infected. You may be moving out of your home indefinitely in order to minimize risk of infecting your family. Your own health and the health of your colleagues are constantly at risk. And, you very likely will need to choose who gets a ventilator during rationed care and could even end up taking care of an intubated friend.
You might also be “redeployed,” a word that invokes military service with its very usage. In this context, however, being redeployed means being asked to practice a different type of medicine than the one you were trained to do. For example, a psychiatrist could be asked to cover internal medicine, or a surgeon could cover an intensive care unit. A physician might even be asked to go work in a different state. Like being a member of the military, being a doctor now means serving others regardless of your own needs.
This duty even supersedes graduations and retirements. In some states, medical students who have not yet graduated are being asked to start working as medical interns. Despite evidence suggesting older people are particularly vulnerable to coronavirus, hundreds of retired physicians are also signing up to go back to work.
The willingness to serve others is a noble, beautiful thing about our workforce. But even for a profession that has historically always placed patient needs first, the degree of sacrifice being demanded of us now is unprecedented. Then, on top of all of these additional stressors, we still try to hold it in.
So what happens if you finally want to talk about — or, even, question — the demands placed on physicians? Early on in medical training, we learned that being a “good doctor” meant respecting the hierarchy, never expressing concern or doubt and always being a good “team player.” When things go seriously wrong in the care of patients, we analyze what happened. Just as is the case with every other failure we know about (for example, Chernobyl), when there have been adverse medical outcomes, there was often someone who could have spoken up but didn’t. This is a direct consequence of the strict hierarchy and culture of silence in medicine.
It’s no surprise, then, that Dr. Ming Lin was fired in Seattle after speaking up and asking for more personal protective equipment. Doctors are supposed to advocate for others but never for ourselves, lest we seem selfish or unappreciative. If it seems like we are exaggerating, keep in mind that doctors almost never take sick days because we don’t want to let down our patients or burden our colleagues. We also worry about parental leave for the same reason. If we don’t take adequate time for ourselves even when we have brought a new life into the world, can you imagine a doctor saying no to redeployment?
We can’t either. But that does not mean we should not talk about it and discuss and process the difficulties and emotions associated with all of these challenges. It does not mean we shouldn’t advocate for and support each other and even cry if we need to. Those of us who do cry or speak up, even publicly, are not worse doctors for it.
All over this country, doctors are putting on a brave face as they walk into hospitals knowing they might become infected. We know mental health outcomes in frontline providers are real and tangible, and happened at high prevalences in China, and we can only expect that to happen here. In private online groups and personal conversations, many are frightened and tearful, desperate to gain some control over their environment, trying to combat their inability to protect themselves and their loved ones.
So go ahead, clap and cheer for doctors — we need that right now. But also allow us space to be human. We need to cry, scream, and be able to tell the truth, too. We don’t want to end up crushing these medical professionals who are carrying too much weight as it is.
Arghavan Salles, MD, PhD is a scholar in residence at Stanford University School of Medicine. She is also a surgeon. Find her on Twitter here.
Jessica Gold, MD, MS, is an assistant professor in the department of psychiatry at Washington University in St. Louis. Find her on Twitter here.