In medicine we get taught how to be a medical student, how to dress and how to act, and then we get taught how to be a ‘doctor’, how to talk, dress and act. Most of us go through life thinking of ourselves as being either a ‘medical student’ or then ‘a doctor’ and these roles become so ingrained as part of ‘who we are’ that we are unable to separate ourselves from it.
In my twenties, I remember going out and meeting people, not wanting them to know I was a ‘doctor’ (especially the guys, in case they felt intimidated and ran away… *doh* !!) but then being unable to talk to them as me anyway – even though I was being ‘social’, I was always in that ‘doctor’ mode of question and answer and efficient interrogation with the provision of answers and solutions! It’s how we’re trained to communicate! It was agonising! Nothing I could do could get rid of that way of being with people, it was so ingrained, and then it became so ingrained, that I didn’t even realise I was in ‘doctoring mode’ the whole time… and I know that I am not alone in this as I have seen it everywhere in medicine!
We’re so ingrained to think of ourselves as ‘doctors’ and we spend so many long and ridiculously long hours trying to ‘become’ a ‘doctor’ and then to become not just a doctor, but a ‘specialist doctor’. We are referred to as ‘doctors’ everywhere we go, from census forms, hotel bookings to drivers licenses and bookings for flights. ‘Doctor’ is our title that precedes us, everywhere that we go, but:
Do we ever stop to consider that we are people, the lovely man or woman that we are, and not ‘doctors’?
Do we consider that we are people, and that we just happen to be in the service provision of medicine where we happen to be given the special title of ‘doctor’?
In medicine, we lose ourselves as people, as we are taught to be something that we are not and we become defined by our ‘title’ and all of its associated expectations and ideals, without even realising.
In our training, from medical school up until our specialist qualifications, we are taught to be in a particular role, and everything about us is refined, trained, and educated:
- From the way that we speak
- To the particular rotas of ‘suitable’ questions that we have to ask
- To the exact questions that we have to ask
- To the suitable sympathetic response to questioning
- From the way that we have to ask the questions
- To the order we need to ask the questions in
- To the way that we have to communicate information with our peers
- To the language that we have to learn
- To the way that we are expected to dress, look and sound as part of the ‘professional’ ideal
- To the way that we are expected to think and make decisions
- To the way that we interact with people full stop.
We are well and truly programmed to be the perfect ‘doctor’, whatever that might be and there is exhaustive and extensive study, training and examinations in that regard to confirm and ingrain it all.
There is nothing in our training about us being people, about celebrating and being the people that we are, or about us being people who are worth taking care of and who need to take care of themselves. Nor are we trained that just like people, we all need support and that it is great to ask for help. Instead, as ‘doctors’ we need to be the ones who know and never ask for help.
Instead of being nurtured as people, on an equal footing with everyone else that we work with and see, we are supposed to be ‘perfect’, more infallible than the pope, the ones in ‘control’ at all times: that is how we are taught to be. Control. Control. Control! Forget control tower, we are control doctors.
The buck stops with us. If we don’t know it; if we don’t have the answer or the solution, (which is by the way, not humanly possible) then well, ‘its all over!’.
We must have the right answer, be available at all times, have no human needs, weaknesses or fragilities otherwise we are considered to be ‘unprofessional’. Lunch break? Why are you not at the beck and call of whoever needs you whenever… not answering your page within 2 seconds – who do you think you are!!
That’s how we are educated to think.
We are always in the role of:
- In charge
- Knowing with the answers
- Having to have the answers
- Having to provide a solution to fix everything (not humanly possible by the way…)
- Responsible for everything, even peoples’ choices and decisions for themselves
- Running late because we are so busy
- Time pressured
- Being perfect (also not humanly possible by the way…)
- Never making mistakes – or else.
And everyone else is in the role of ‘other’, usually ‘patient’, the person from whom we need to ‘extract information’ and tell what to do.
Our ‘role’ despite our innate nature and best intentions, is not actually truly equal with the person, aka ‘patient’ that we are seeing.
The role never sees the ‘doctor’ as a person with human fragilities, vulnerabilities, sensitivities, or human rights, nor does it see the person seeing the doctor as a person, but rather a ‘patient’ with a ‘disease’ who needs ‘fixing’.
As doctors we are not trained or allowed to see ourselves as the gorgeous sensitive people that we are, but rather in the eyes and the grind and pressure of all of the expectations and responsibilities that are placed upon us as to how we need to be and what we need to provide, whether it is humanly possible or not (and usually, it is not!!) but in the role, we will try and make it happen, and, feel like a failure if we can’t make it happen!
Not seeing ourselves as people, also means that we do not see other people as people either, but also rather in their ‘role’ such as ‘patient’, ‘nurse’, ‘receptionist’ or ‘other health care provider’.
This is a divide between us all.
If we don’t see ourselves as people and the people seeing us as people, or the people we work with as people, there is no equality in the relationship as roles by their very nature are not equal; there is always a power imbalance. There is never a power imbalance between 2 ‘people’.
Deep down, we all know that we are equal, and we went into medicine because we care deeply about people, but there is this ‘role’ and ‘mode’ of ‘doctor’ that we are trained and ingrained in which gets in the way!
This role, which is the culture of health care, creates a divide between first ourselves as people and ‘the role’, and then other people being seen as people, as the role holds others in a role as well!
The culture of health care holds us all as ‘roles’ whether we be health care providers such as doctors, physios, or nurses, or, patients. Never are any of us seen as simply ‘people’.
People are all equal, no matter what ‘role’ they are in, and each person brings something profound to this life, and to the profession of health care.
Each person has their own personality and their own way of expressing, and this is one of the beautiful things about us.
Yet, in medicine, we all become quite formulaic, we start to be homogenised, we are trained to be homogenised, and the white coat is symbolic of this supposed ‘knowledge interchangeability’.
Most of us lose who we are after being medical students, and more particularly after we start working as there is a particular professional groove that we fall into and are trained to go into. We are not trained to be who we are as people, but rather the ‘suitable role’ of doctor.
There is a particular professional ‘face’ that meets peer approval. You can’t be too joyful, or playful or it is frowned upon as not being ‘serious’.
You can’t show emotion, or distress, and you have to be this mysterious thing called ‘professional’ with people, (which is code for ‘don’t treat people like they are people, keep your distance and never let them see who you really are…..’)
We become so ingrained in ways of trained communication, with us on one side of the consulting desk, and patients on the other, that it becomes the way that we are with people in general, without us even realising.
It becomes our protection in life, as well as our prison.
We are the ones supposedly in control of every personal interaction, yet, in quality human interactions it is desirable that there is equality in interactions, respect, and connection. Control has one in power and the other not…
I have a particular colleague who I love dearly, who when he has decided he has had enough time talking to me stands up to get up to the door to walk me out as though I am a patient with whom the consultation has ended! [I note here that this is not the way that ordinary people communicate with each other…]
The people who go into medicine are deeply caring of other people, deeply sensitive, and want to make a difference.
In medicine, we are considered by the system to be ‘doctors’ and not sensitive, caring people. We are considered to be replaceable interchangeable ‘resources’, a ‘financial liability’ that needs to be minimised, a ‘resource’ that needs to be managed, and controlled. We are not valued or cared for as the people that we are. You are a ‘doctor’ filling a ‘position’. Nurses have courses on how to ‘manage’ doctors.
There is enormous abuse that we accept and endure in the health care system in the ‘role’ of ‘doctor’.
We accept (and are expected to) working 12-16 hour shifts, sometimes without extra overtime pay or penalty rates at the expense of our own health and families as part of our ‘dedication’ to others.
In the case of the NHS we are simply told to take a 30% pay cut from a wage and working conditions that are already far worse than our intellectual and educated peers in other professions and told to work even longer hours than we already are, (with zero appreciation for the service and dedication being offered) to help provide a free 24/7 health care service to the country – are we indentured slaves?!!
We accept less pay as we consider that we are there to ‘serve’ others – but here I note so are accountants, and every other profession… all professions serve other people and help them out.
As ‘doctors’ we accept the bullying, time pressures, lack of care, open hostilities, demands and blames and disrespect because it is just what you expect as ‘doctors’.
We do not even notice that we are being bullied or pushed to work in inhumane ways with no self care and no permission for self care granted. I have spoken to medical students who are being sexually harassed, who didn’t even realise it was sexual harassment until it was pointed out, and then they didn’t want to take action in case it affected their marks…
We work in an environment that does not care for us, where we are not treated with compassion or humanity, simply because we are ‘doctors’. We are not allowed to cry, show any sign of emotion, or that we are affected by things, simply because we are ‘doctors’.
We have to bury our feelings because we are ‘doctors’.
We have to go without sleep, study 3 hours a night after long hours of work, for many years after graduation from an already arduous course because we are ‘doctors’ and want to be doctors.
We are expected to work for free, and thought to be greedy for charging fees for our services because we are ‘doctors’. No one else is pressured to provide a free service. Food is a human need, but I still have to pay when I go to a restaurant and the supermarket!
There is a huge stigma for us to get sick and further even more to take time off work to recover, because we are ‘doctors’. Perhaps one day here and there, but, don’t make it a habit, or else… its not considered ‘professional’ to be sick as a doctor, and particularly ‘unprofessional’ to have a mental health disorder, especially if people know about it…
In the medical culture, there is a stigma for us to be ‘patients’ and seek health care help because we are ‘doctors’. This is having a negative impact on our health and well-being.
There are huge and unrealistic expectations placed on the ‘role’ of doctor, including expectations that we should control the decisions that people are making in their lives regarding their health care in order for them to have ‘good results’!
This is a huge pressure – people can’t control people, nor should they as there is such a thing recognised as Free Will and Self Determination. Yet somehow, when it comes to the roles of ‘doctor’ and ‘patient’, fundamental human rights fly right out of the window… In fact, there are now moves afoot in Australia to pay doctors in primary care according to the ‘results’ they get in their patients with chronic diseases…
If we saw ourselves as people, equal to everyone else, with human rights, sensitivities, and fragilities, would we allow the abuse?
Would we expect more of ourselves as people than anyone else?
And would we accept the blame for the choices that other people make?
If we were seen as people, just like everybody else with sensitivities, and vulnerabilities who need to be cared for, would we be abused as much? And, would we abuse ourselves so much…
As ‘doctors’, there is the culture of not taking care of yourself, but as ‘people’, would we not give ourselves more permission to take care of ourselves, knowing that we were worth caring for?
And accept that it is natural to be human and imperfect, even with a medical degree…
We are all people in life, with loving caring hearts, families, friends and relationships. We all want to love and to be loved. It is natural and innate.
We are all equal, and it is a simple turn of events that can have us on either side of the ‘consulting bed/table’ seeking assistance but that side we are on does not define who we are as people whether we are in the role of doctor, or patient.
In life we are all trained in particular different skill sets. Some are trained to do accounting, finance, plumbing, carpentry, dressmaking and so on. All of these skills are needed by us as a society and together we live, turning to each other for support as nobody can bring it all themselves.
It is natural and needed that we seek out others who have a particular expertise in a field. But that does not mean that we are less than that person simply because we do not know what they know.
And it is the same in medicine.
As doctors we are people, and we are equal to our patients, who are also people.
We are all people, just someone is seeking some advice, and we are giving advice with our expertise.
We are not endowed with special all knowing and all curing powers simply with the title or the qualification of doctor; what we have is a particular skill set and the enormous value that we offer people as the gorgeous people that we are.
To do the role of doctor does not mean that we have to sacrifice our humanity. It is our humanity that brings the healing and the care to the role and the human interaction.
We do not need to lose or let go of who we are just because we do medicine.
In fact WHO we are is what brings a value to the medicine that we do.
As long as we consider ourselves to be ‘doctors’ and not people, we will be caught in the cycle of abuse, and lack of self care, and ill health and burnout.
When we start to see ourselves as people, we will start to give ourselves permission to look after ourselves, and a whole lot of stress and strain of the system will be lifted from us.
It is when we start to see ourselves as people that the system will change, one person at a time.
No ‘doctor’ will ever change the system for the true good, but people bring changes through bringing sensitivity, care and love to people within the system whether they be patients, or doctors.
Our health care system is in trouble, from its ability to provide health care services, to the way it treats the health care staff.
True change comes when we see and know that we are people.
True change in medicine comes when we care for ourselves as people and live that care with everyone.
The end. Dr Maxine Szramka