Breaking the martyrdom trap in medicine

In medicine, self-sacrifice is praised. We call it dedication. We call it loyalty. However, sometimes it is just exhaustion wearing a badge of honor, and it keeps us complicit in systems that harm us and our patients.

Burnout does not kick the door in. It just shows up quietly. One day you notice you have not called a friend back in weeks. Lunch, if you can call it that, is an energy bar eaten half-unwrapped, leaning over the Pyxis medication cabinet in the corner of the unit while you check the next medication order. Your signature, once legible, has turned into a tired horizontal line on the consent form. And you tell yourself it is fine. Temporary. This season. This rotation. This job. Meanwhile, the profession smiles and nods.

Medicine has always carried this quiet ideal of self-erasure. In the Middle Ages, the physician-healer was often cast like a priest, someone expected to absorb suffering without complaint. Christianity added its own twist: The physician-as-martyr, proving faith and worth through exhaustion, even death. Later, the language shifted to the military’s lexicon: Front lines, battle fatigue, soldiering on. Florence Nightingale’s near-mythic stamina in the Crimean War cemented the idea that the “real” healer works through illness, fever, and pain. Even Osler’s famous “equanimity,” intended as a call for steadiness, can be bent into something else: A quiet prescription for emotional silence. Along with the scalpel and the stethoscope, we inherit the script: Give until you are empty, then keep going.

Hospitals understand this. So do governments, insurers, and administrators. Burnout is not an accident. It is baked into the business model, and it is rewarded. The doctor who stays late is a “team player.” The one who skips vacation is “dedicated.” Hero stories thrive in a crisis because they turn overextension into something noble. In early COVID-19, I heard physicians almost competing over who was more exhausted, as if depletion itself proved authenticity.

One ICU attending I coach told me she knew she was valued when her chair said, “You are always the one we can count on.” Three bouts of pneumonia in two years later, she realized it had not been praise at all. It was conscription. And that is where the trap closes. Martyrdom breeds complicity. Exhaustion narrows your field of vision. The doctors most worn down are often the least able to imagine stepping away, even briefly. They have been in survival mode so long that stopping feels like betrayal. In some cases, the pager feels like part of the body. That is the final sleight of hand in the martyrdom trap: Making endurance look like loyalty, and protest look like desertion.

Psychology even has a name for it: Pathological altruism, helping to the point where you harm yourself, and in the process, harm those you are trying to help. Add learned industriousness, valuing only what feels difficult, and you get a profession that treats rest as weakness. I have seen it—a mid-career surgeon more afraid of being called “unreliable” than of losing her health, and a pediatrician in the NHS who routinely worked twelve-hour shifts without lunch rather than “let the team down.” These are not rare cases. They are the baseline, and that baseline keeps strikes in the U.S. rare, short, and often hesitant.

Elsewhere, the script loosens. In the recent NHS strikes, British doctors, long steeped in stoicism, still felt guilt about walking out but framed the act as care, not abandonment. Here, where identity clings hard to individual heroism, that leap to collective protest is harder to make. Frankl said suffering has meaning only if we choose our response; otherwise, it is just pain. Yalom pushes the point: If the right choice is to confront what is broken, especially in the systems we serve, then backing away is not neutral. It is a kind of existential cowardice.

The point is not to stop caring. It is to stop bleeding for a machine that will not heal you, and will not heal itself. That is why strikes, though messy and disruptive, can be the most moral choice left. They strip away the illusion that personal sacrifice can repair systemic neglect. They say: We will no longer collude in our own depletion. The first strike might not be public. It might be private: Sleeping instead of covering another shift, taking the vacation you have earned, saying no when yes would only serve the institution, not the patient.

These quieter refusals can be harder than the noisy ones. They mean redefining loyalty: Not as staying until collapse, but as staying in the profession long enough, and whole enough, to matter. If you were your own patient, would you prescribe more of what you are doing now? More sixteen-hour days? More skipped meals? More time away from the people who love you? If the answer is no, then you already know something has to change.

The martyrdom trap is seductive because it dresses self-destruction in the clothes of honor. However, no profession can survive if its members die for it faster than they can be replaced. No patient benefits from a doctor who is present in body but absent in spirit. Burnout is not a badge of honor. It is a warning light. Ignore it, and you may help bring about the collapse you claim to resist. The real badge of honor? To stand, still whole, beside your colleagues and say: This is where I draw the line.

Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.

Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.

Patrick is the author of the Coaching for Physicians series, including:

He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.