I recently came across an ongoing “discussion,” or rather aggressive bantering, in an online physician platform regarding the old guard versus the alleged newer, more entitled, and lazy generation of doctors. Years ago, I would have more staunchly fallen on the side of the old guard. Though I am a solid elder millennial, my “bootstrap” upbringing and Navy career fully encouraged the concept of medicine as a calling vice a job. I still cling, somewhat, to the fact that the Hippocratic oath is as strong as my Oath of Office to the United States Navy and want to believe that my commitment to the greater good, despite its costs, is worth the sacrifice.

But I also have grown ever more progressive, liberal, and skeptical of so much of what I used to believe as I have entered my 40s. With that comes a heavy dose of personal inquisition and questioning of my own motivations and biases. For that reason, I find myself more defensive of those of my generation or after and willing to entertain the idea that the old guard was not only wrong but overwhelmingly destructive to the practice of medicine and society at large. Mainly because the same giants who roamed the halls of hospitals refused to dirty their hands with politics and were perfectly fine with perpetuating the abuse of those around them to accentuate their power and stamp their name into a pillar of society that demanded respect, prestige, and obedience.

The same giants who worked for 100 hours a week for years after training, creating and developing the future of medicine, also used the labor of their wives, missed the lives of their children, and verbally and sometimes physically assaulted those who helped them in their endeavors inside the walls of the hospital. Often, any ability to question or restrain that power was met with swift dismissal. In some cases, that power still exists today, though the motivations may be slightly different. The advances and successes are not questioned, but the means to which these ends were met are bereft with concerns and, at times, literal human rights violations.

While the secrets stalked the confines of hospitals and labs across the country, those same physicians refused to be seen as political or biased—especially if the politics or bias was not rooted in systemic racism or the perpetuation of the patriarchal society from which they benefited. Some may say they were morally opposed to being seen as “taking sides.” But many of us would step back and wonder if the politics to which they were so allergic wasn’t attractive because it would allow for their power and prestige to be questioned while elevating those they once controlled into a position of power.

Maybe this is why those who were willing to be political in medicine historically came from marginalized communities with less guarantee of high pay or power—namely pediatrics, adult primary care, psychiatry, and obstetrics. This left the rest of us to be represented by those who limited their advocacy to topics considered “safe”: money, reimbursement, and preservation of scope of practice. These topics are not without relevance, but the lack of engagement in the rest of the political spectrum calls into question the moral compass of those who always swore that their oath to their patients was worth the damage done to their family, friends, and non-physician medical colleagues.

This brings us to Inauguration Day. a pivotal moment in time. It feels as though progress is at risk of being undone, as we reflect on the contributions and advances made by previous generations. Challenges persist, with divisions and misunderstandings creating barriers to unity and collaboration. In some ways, it seems we are returning to a dynamic where certain roles and responsibilities are narrowly defined, limiting opportunities for growth and independence. Those seeking to challenge the status quo and advocate for positive change often face resistance, exposing the complexities of maintaining balance between tradition and progress. The tension between preserving established systems and embracing new ideas highlights the importance of thoughtful and inclusive dialogue moving forward.

No one wants to believe that their commitment to something they always believed in is a commitment to a system of oppression or abuse. As a veteran and a physician, I struggle daily with the question of whether raising my right hand and accepting the white coat was an act of bravery or an act of submission. I want to believe that there was something inside both of these communities worth fighting for, that there were people to learn from, and lessons to teach others that would never have been available to me without those oaths being taken. A courageous hope that there might still be something of value deep within the foundational act of service I so desperately searched for when joining these organizations or practices.

That is where I stand today—on a kernel of hope buried beneath the giants who came before us. Buried by those who never wanted us there in the first place. Buried by the hypocrisy of equality and freedom for all. Buried by apolitical neutrality. But powered and fed by those whose mind, body, and souls were used to build these pillars on which society sits. We can pull ourselves forward together, but only with the intentional deconstruction of all we were taught to believe. There were never giants—only backs on which mere men stood.

Nicole M. King is an anesthesiologist and intensivist.