Why physician strikes are a form of hospice

I have only recently started thinking about strikes. They seemed like something other people did: railway workers, bus drivers, teachers, dockworkers. People with contracts. People who clocked in and out. Not doctors. Not surgeons. Certainly not me.

You and I were supposed to absorb and adapt. To advocate from within. And we did, for a long time. We bent ourselves into shapes that did not fit. Worked around all the broken processes. Made phone calls after hours. Took the extra shift. Rewrote the notes to satisfy a system that did not understand the work. Until, eventually, some of us stopped. Not because we wanted to burn it all down, but because we could not keep pretending.

And that is what a strike is, sometimes. Not rebellion. Not rage. Just a line and a refusal. And an end to the performance. Is it not strange how long you can work inside a system that is eating itself?

You still go in. You still care. And you show up for the patient in front of you. But do you acknowledge something has changed? Can you not feel it? When the work no longer connects to meaning. You begin to feel like a technician, or you are in a play with administrators as directors and a rotating cast of slogans behind the curtain. And when you name it, out loud, it does not feel like catharsis. It feels like grief.

No one told me, did they tell you? The thing you are mourning is not the past. It is the future you thought you were part of. The version of medicine you trained for, the one where ethics were not optional. Where showing up still meant something. The one where you could still believe your work was for the patient, not the platform.

I remember a registrar telling me, during a strike in London, “I am not angry, I am dissolving.” I knew what she meant. It was not about money. It was about memory. And hope. About losing the sense that what she was doing still resembled the profession she thought she had joined.

Some strikes begin as self-preservation. You stop trying to fix what is not worth repairing. You step back not to punish anyone, but to stop being reshaped by something you can no longer respect. It is not the heroic narrative. There is no applause. No grand statement. Just an absence. A line drawn. And sometimes that is the most ethical thing you can do.

You know what hospice looks like. You have sat at bedsides. Turned off the IVs. You have said, “We are shifting goals now.” It is not surrender. It is clarity. That is how some doctors are treating medicine itself. Not something to fight. Something to sit with and hold hands as it declines. To name it. To make the exit honest.

We call it a strike, but maybe that is not the right word. Perhaps it is a witnessing. The final form of care a profession can offer itself when it no longer functions.

You do not strike because you have stopped caring. You strike because you remember when it mattered.

I understand. Some cannot walk out. You have children. Loans. Visas. You stay because you have to. You should not feel ashamed for that. But staying has its own cost. Not in hours but in erosion. Every day, you make decisions that do not feel like you. You click boxes that do not mean anything. You reorder your values to match someone else’s metrics. And you tell yourself it is just for now, just until the system changes. But it does not. And over time, something starts to rot in the space between your intention and your action.

We do not talk about that. There is no CME module for moral futility.

You have seen it; it is everywhere. People think collapse is loud. But it is not. It is incremental. Sometimes even professional. It arrives wearing a lanyard and carrying a clipboard. And if you say nothing, it pretends to be care.

And that is why strikes matter, not because they fix things, but because they make the erosion visible. They force the lie to stop at least for a moment. The system is not broken. It is functioning as designed, and that is the problem.

For some of us, the only thing left is to stop living the fiction. I have no idea what comes next. Perhaps nothing. Maybe worse. Perhaps some small thread of honesty we can follow out of the wreckage. But I do know this: Some of the most ethical physicians I have known have stopped trying to fix it. Not out of cynicism but out of respect. For themselves. For the profession they remember. For the future that might still be possible if we tell the truth now. Even if it costs us. Perhaps, especially then.

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.