“I want you to be proud of me,” my intern replied when I asked what he wanted to get out of the rest of his year. We were wrapping up the first two weeks of July—his first two weeks of being a doctor—and having our end-of-rotation feedback session. However, he had just flipped the tables on me. His comment was the type of jolting response that made me rethink my performance as an attending. As I have matured from a young, determined doctor to an older, occasionally paternal, attending, I had not realized the importance of pride and why being proud is important.
The beginning of July is a time to be proud. Academic medical centers are filled with excitement and trepidation as new classes of interns start, and other residents ascend to the next level of responsibility. This was my twenty-fifth stint doctoring at the beginning of July, and I have become increasingly proud of my students and residents. Becoming a doctor is a dream of many people, yet not everyone who has this dream is able to become a physician. We do not celebrate this achievement enough. For some learners, we have specific reasons to be proud.
Consider one of my students. She is a Black woman. As we introduced ourselves to patients on rounds, several patients—specifically older, Black women—lit up when she introduced herself. While to me, she is just another student on my team, to them, she represents something more.
These women were born in Virginia in the 1940s and 1950s. They lived under segregation. They experienced “separate and equal” and know it was separate but not equal. They experienced the pain of integration when explicit segregation was replaced by tacit discrimination. They saw the election of a Black president and the subsequent backlash. Now, before them, they see a young Black woman who may represent a dream they may not have been allowed to dream, much less achieve. They are proud of her, and we can be proud of that.
But the story of this student’s achievement is only a part of the intersecting narratives in a hospital. We also cared for a patient whose tattoos endorsed white supremacy. He had lived a troubled life including prolonged incarceration. Perhaps, he is not the same person now as he was when he got those tattoos, but that did not matter to us. As a team, we talked about how we would deliver him the best care we could, whatever his tattoos might represent. We seek to hold ourselves to a standard for equity that may be higher than our broader society.
Our hospitals may be society’s biggest crossroads, and that can demand a lot of us. Patients, their families, and health care workers from all different backgrounds interact with each other. We are interdependent, and diseases rarely discriminate. Even if people come to our doors with hate in their hearts, we care for them. I take pride in that.
We must be careful with pride, though. Pride is sometimes divided into authentic pride and hubristic pride. Authentic pride is what I feel when I see the faces of my Black patients light up when they see a learner of color. Authentic pride is when I see my learners leave our two weeks together closer to their aspiration of being a good doctor. Authentic pride is true achievement.
Hubristic pride is not based on current achievement but rather on beliefs or past achievements. For example, we have built a better health care system in the United States. It is more equitable, more technologically advanced, and more able to save people from all sorts of maladies. Yet, we know it has problems: too many mothers and babies die, we lose patients to addiction, and bureaucracy and cost hamper care. To take pride in the U.S. health care system would be hubris and ignore the fact that authentic pride requires us to keep getting better.
As I enter my twenty-fifth year as a physician, I have a lot to be proud of. I have helped many patients and trained countless learners to be better doctors. While I take pride in these accomplishments, I need to remember the real goal is to continue to get better. Someday, I may be an older adult in a hospital bed, and the team may come around to see me. I know I will feel proud of them, their accomplishments, and all the obstacles they may have overcome to be at my bedside. For the moment, I want to keep getting better as a doctor and a teacher as we work toward better care for everyone. I hope I will make my team proud.
Alan Dow is an internal medicine physician.
