Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to lose your compassion: the brutal reality of medical internship

Qais Iqbal, MD
Education
January 27, 2024
Share
Tweet
Share

Not all at once, just slowly enough that you don’t notice.

“I’m having a rough go at it,” Mr. Robinson confesses. He was listening to me use choppy, challenging vocabulary to piece together what’s landed him in the hospital.

But I know what he’s talking about. The mass in his chest that’s been compressing on his airway, making him so sick, so quickly. He is talking about his pneumonia: the fevers, chills, sleeplessness; the increasing breathlessness, fatigue, and misery. He’s talking about this new chapter in his story.

The words slip away from me: “I’m sorry, but …”

Then, all at once, I realized that it was gone.

I let go of the words like I was in a rush. As if it would have been too much to pause, to let a moment pass, to hold the space between us in silence. The words felt cold, and they spilled from me without emotion. I could not hold his eyes as I said them, but as I retraced my vision, I saw now that he was looking past me.

This was during my intern year of medical residency.

The evidence for compassion in medical care is clear. It works. It reduces health care costs, leads to improved outcomes, increases patient adherence and satisfaction, and even improves physician self-perception and mental health.

In medical school, like most aspiring physicians, my classmates and I participated in robust training aimed at promoting empathy and compassion. We did role-playing in the classroom, worked with standardized patients, and rewatched recordings of our encounters to hone in on our actions. We learned how to identify non-verbal signs of emotion and instances when compassionate engagement was warranted. We practiced specific actions such as maintaining eye contact, displaying facial expressions, and offering a hand to hold. We were trained to acknowledge, support, and validate our patients. We were taught to be calm, patient, and to treat the whole person, not just the disease. I was proud that my medical education had such a focus on humanity.

But the reality of intern year is different. Every day there are emails asking you to complete your notes immediately, text messages prompting you to include higher billing diagnoses in your charting, case managers inquiring about when a patient can leave. We receive training during orientation about Geometric Mean Length of Stay but not on the time it takes to calm a patient. We are told “hospital metrics” are the new trend – no, the new norm, and actually it’s better to be well acquainted if you want to be anybody in today’s world of medicine.

There isn’t a daily circular to spend that extra minute with your patient. There is no incentive to hold space for sorrow, or validation, or silence. Kindness is a nice-to-have in our medical world.

When time is limited, fatigue is persistent, and working memory is restricted, compassion and kindness are the characteristics that suffer first. Everyone who has been a first-year resident has lived this.

The reality of medical training is brutal, and although the events and environments that contribute toward this are varied, the outcomes speak for themselves. Medical residents experience depression and depressive symptoms at over three times the rate of the general population, and the prevalence clearly increases as trainees become more senior. Suicide is the second most common cause of death in medical residents, and suicide as a problem among attending physicians is a behemoth issue in and of itself. But the path to these outcomes is also checkered with hardship.

ADVERTISEMENT

For a long time, the decay of physician well-being was attributed to burnout. Undue emphasis was placed on training for “resiliency,” establishing healthy well-rounded hobbies, and changing one’s outlook. There was to be ample access to aromatherapy, stress-balls, and mental health counseling for all. But many of us realized that no amount of resilience could right a rotten system.

No amount of training or preparation can alter the reality of a system that is built for efficiency – for increased output. Patients admitted, diagnoses identified, treatments dispensed, outpatient referrals specified, and discharges submitted. As Assistant Professor of Medicine at Harvard Medical School, Dr. Amy Ship aptly summarized, “there is no billing code for compassion.”

Although I am simplifying the world of medicine, the reality is that when you are at the front line, overloaded and overwhelmed, this is what the truth of the world feels like. We went into medicine to make a difference and instead, the emphasis on productivity and efficiency, and making medical decisions based implicitly on financial incentives, leads us to feel morally injured. It depletes us. And we lose sense of who we are and the kindness with which we first came to medicine.

There isn’t a single solution. Attacking the current corporatization of medicine is one front. Disarming insurance giants of their sway over medical decision making is another. Managing the ever-growing burden on resident physicians is yet another.

There are paths to these solutions. Unions offer pragmatic approaches to collective bargaining that enables residents and physicians to demand what is fair and just for themselves and for their patients. Another avenue is to increase political representation and lobbying of officials to begin to unravel the twisted relationship of insurance companies and their meddling with everyday medical decision making. Lastly, each of us can highlight the changes we’ve seen in ourselves as we’ve battled with the medical world.

Continuing to speak about these issues and engaging with one another is how we can continue to make progress. These systems-level changes are necessary to improve our person-level behaviors. We can and should work towards a culture in which residents like me may be able to better offer their compassion.

Qais Iqbal is a radiology resident.

Prev

The Federal SAVE Act: a beacon of hope for health care worker safety

January 27, 2024 Kevin 0
…
Next

A physician's journey in Cuba reveals surprising faith and resilience [PODCAST]

January 27, 2024 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
The Federal SAVE Act: a beacon of hope for health care worker safety
Next Post >
A physician's journey in Cuba reveals surprising faith and resilience [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • How the COVID-19 pandemic highlights the need for social media training in medical education 

    Oscar Chen, Sera Choi, and Clara Seong
  • End medical school grades

    Adam Lieber
  • Navigating mental health challenges in medical education

    Carter Do
  • The role of income in medical school acceptance

    Carter Do
  • Medical ethics and medical school: a student’s perspective

    Jacob Riegler

More in Education

  • Why a fourth year will not fix emergency medicine’s real problems

    Anna Heffron, MD, PhD & Polly Wiltz, DO
  • Do Jewish students face rising bias in holistic admissions?

    Anonymous
  • How dismantling DEI endangers the future of medical care

    Shashank Madhu and Christian Tallo
  • What’s driving medical students away from primary care?

    ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD
  • In the absence of physician mentorship, who will train the next generation of primary care clinicians?

    Kenneth Botelho, DMSc, PA-C
  • The moment I knew medicine needed more than science

    Vaishali Jha
  • Most Popular

  • Past Week

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Surviving kidney disease and reforming patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Antimicrobial resistance: a public health crisis that needs your voice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why a fourth year will not fix emergency medicine’s real problems

      Anna Heffron, MD, PhD & Polly Wiltz, DO | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Surviving kidney disease and reforming patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Antimicrobial resistance: a public health crisis that needs your voice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why a fourth year will not fix emergency medicine’s real problems

      Anna Heffron, MD, PhD & Polly Wiltz, DO | Education
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How to lose your compassion: the brutal reality of medical internship
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...