I was a nurse before I was a PA. As the mantra goes, once a nurse, always a nurse. I have lived on both sides of the toxic structure: the medical and nursing models. Nurses eat their young, then place an unrealistic and unsustainable standard of altruism onto their offspring. Many times, the worthiness of nurses is gauged by how much they are willing to give of themselves, work overtime, or disproportionately give to their patients.

Doctors do the same, but the initiation is more like intellectual trauma. The standard is that they are expected to know and do every aspect of medicine until they are finally somewhat knowledgable enough to function independently, but inevitably the shame cycle continues until they have earned their stripes and proven themselves time after time.

Suppose a medical provider missteps and the environment isn’t conducive to growth. In that case, they risk being labeled incompetent, nonchalant to patient safety, or possibly even not cut out for the job.

I started my career in medicine as a phlebotomy tech. Even at that stage of the game, there were certain hunters poaching my performance for their satisfaction. If they found a flaw in my work, it added a feather to their quiver of perfection.

The problem is that medicine perpetuates perfectionism. The draw to put forth competent providers into a system that requires astute critical thinking is very admirable, but it gets out of hand.

Without proper knowledge of a nurturing environment, the administration can’t provide it. Without proper knowledge of a healthy boundaries, nurses can’t set them in place to take care of themselves in times of high demand. Without realistic exceptions of human capacity, doctors can’t meet standards in a fulfilling capacity.

This standard perpetuates a never-ending hamster wheel of “not enough.” The ancestral patterns of toxic medicine are passed onto the young, just like family trauma is generationally embedded into DNA.

The adage “I endured this, so you will too” must stop for medical practice to be sustainable. The statistics are alarming, and many providers have left, are contemplating their exit, or drowning in the misery of feeling stuck.

A prospect seeking a career in medicine must start with their own awareness of boundaries and perfectionism before entering the field. This inner work must be indoctrinated in schools and encouraged through residencies and mentorships. Furthermore, administration must model this and valued it as highly as continuing education, credentialing, and skill training.

In a profession that is innately human, we have to bring humanity back for it to be sustainable.

Amanda Gwin is a nurse and physician assistant.

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