Were you the one who always held it together? The responsible one? The one who made sure everyone else was okay, sometimes at the cost of your own well-being?

For most eldest daughters, this role is inevitable. We don’t choose it. We are handed it, early and often, because we are so “capable.” We accept this role and excel at it. That’s what most eldest daughters do with whatever is handed to us. Recently, my podcast cohost, another female physician, and I realized we had so many shared “eldest daughter” experiences. Neither of us had ever labeled them as such. We hadn’t even realized we were both eldest daughters in our families.

The concept of the Eldest Daughter effect offered both of us a comforting explanation for how we got here and why we are the way we are. It was so helpful, we decided to share our thoughts about the impact of this on women in medicine on the Healing Medicine Podcast. The response to our discussion was surprising. Women physicians wrote emails to share their gratitude and relief. They felt seen for the first time. While each of our individual eldest daughter stories are unique, our discussion of this phenomenon helped many of us finally understand ourselves and what has happened on our journeys better.

Interestingly, even with this feedback and support, I still didn’t feel brave enough to share the idea of the Eldest Daughter Effect on Women in Medicine more broadly. It still felt edgy and vulnerable, like it might open me up to judgment. I wondered whether my story and this “identity” would resonate beyond the women in my circle. Would others think I was placing blame for a burden I seemed to have chosen? Part of being an eldest daughter is not sharing the pain or our story. We smooth waves, we don’t make them.

The story in my house growing up was that I chose this identity. I liked being in charge. I enjoyed responsibility. Was it expected or did I take it on? At 56, it’s hard to know the “real” story. My parents are now in their mid-eighties. Our stories about what happened are not the same. Each of our “stories” has taken on a life of its own. The “real” story doesn’t even matter anymore. Somewhere along the way, being the one who manages, absorbs, and shows up no matter what became my role and my identity. I got a lot of positive reinforcement, which led to a lot of accomplishments, including becoming a woman physician.

Why am I choosing to share this more broadly now? The media buzz about Taylor Swift’s Eldest Daughter new release gave me courage. Her stories resonate broadly. It helped me lean into my belief that there is something to my experience as well as that of my women colleagues in medicine who are also eldest daughters. It turns out there are a lot of us.

The “Eldest Daughter Syndrome” seems to be magnified for women in medicine. Caregiving and over-responsibility begin long before medical school for most of us. For most of us, it started in childhood: with packing our own lunchboxes and childcare responsibilities for our siblings often well beyond what should be expected for someone of our age. Most of us took on managing and minimizing family chaos. Many of us helped pack for trips. Almost all helped make dinner when necessary. Our exact roles looked different. What we share was the skill of noticing what needs to be done and doing it, without being asked.

Our attentiveness, competence, and hyper-preparedness were rewarded, first at home, then at school, and later in the hospital. They became a currency in a health care system that values sacrifice. We are taught that this is what it means to be a good doctor, a good daughter, and a good human. Eldest daughters almost always say yes to extra shifts, committee work, and requests for favors. We fix problems before anyone else even sees them and we pride ourselves on being indispensable. The system is more than happy to let us believe it and be it.

Eventually, this all becomes “expensive,” emotionally and energetically. Eldest daughters become exhausted, resentful, and burned out from ignoring ourselves to be what others want and need. Our physical bodies often wear down earlier than expected. Chronic health problems, early cancer diagnoses, and autoimmune diseases are not uncommon in eldest daughters. A recent Time magazine article written about “the cost of caring” calls out the phenomenon that while women usually live longer than men, in medicine they do not.

Letting go of the “Eldest Daughter identity” is tender and uncomfortable work. Every time a woman physician who is also an eldest daughter chooses to rest, says no, asks for help, leaves something undone, or lets someone else step up, we begin to shift. What we practice grows. We can learn to stop saying “yes” from obligation or expectation and only agree when saying “yes” comes from a place of choice, alignment, and love, for ourselves and others. With practice, self-compassion, and time, we can learn to care for ourselves “as well.”

Jessie Mahoney is a board-certified pediatrician, certified coach, mindfulness and yoga teacher, and the founder of Pause & Presence Coaching & Retreats. After nearly two decades as a physician leader at the Permanente Medical Group/Kaiser, she stepped outside the traditional medical model to reimagine what sustainable well-being in health care could look like. She can also be reached on Facebook and Instagram.

Dr. Mahoney’s work challenges the culture of overwork and self-sacrifice in medicine. She helps physicians and leaders cultivate clarity, intention, and balance—leveraging mindfulness, coaching, yoga, and lifestyle medicine to create deep and lasting change. Her CME retreats offer a transformative space for healing, self-discovery, and renewal.

As co-host of the podcast, Healing Medicine, she brings self-compassion and presence into the conversation around modern medical practice. A sought-after speaker and consultant, she partners with organizations to build more human-centered, sustainable, and inspired medical cultures.

Dr. Mahoney is a graduate of Dartmouth College and the University of California, San Francisco, School of Medicine.