Something very distinctive happens once students complete medical school and residency: some of them start acting like excrement. Not all, but enough that most of us have witnessed the transformation. Maybe you’ve noticed it in your mentees, or in the children of friends and colleagues who went into medicine. Maybe, uncomfortably, you’ve wondered if it happened to your own children. And, if you’re like me, reflecting at the tail end of your career, you may even wonder if it once happened to you.

Why does the shift occur? Is medicine uniquely capable of hardening people over time, or do all high-stress professions (law, policing, public service) risk reshaping our personalities?

Lately I’ve been thinking about these questions more consciously than I ever did when I was younger. Some of it comes with distance: Once you step back from medicine, paradoxically, you see the culture more clearly (“I Can See Clearly Now,” as the song goes). Some of it comes from watching the children of friends grow into doctors and, in some cases, into less generous versions of themselves. And some of it traces back to a recent rerun of Blue Bloods (“Pick Your Poison”), which offers a provocative alternative: Maybe our jobs don’t change us so much as they magnify what was already there.

In the episode, a leader of a neighborhood watch group (an ex-cop) tries to cloak his racism in the language of public safety. Detective Danny Reagan (Donnie Wahlberg) sees right through him. Their confrontation ends with the racist insisting the police force “made him this way.” Later, Danny dismisses the excuse outright. The job didn’t make him a bigot, Danny suggests; it simply gave an outlet to qualities that were there all along.

Which brings us back to medicine. Does the profession intensify traits we already carry (rigidity, impatience, arrogance) or do we acquire these behaviors as protective gear against the trauma and dehumanization that accompany medical training? Anyone who remembers The House of God doesn’t need a long list to recall what trainees are exposed to.

After watching Blue Bloods and combing through the medical literature, I find myself agreeing with Detective Reagan. I don’t think medical training permanently alters our personalities or brings out the worst in us. Instead, maladaptive behaviors tend to emerge as coping mechanisms in response to chronic stress, emotional overload, and the culturally sanctioned stoicism that medical education demands.

Many of us learn early on to suppress our emotions in the name of professionalism. What begins as a survival tactic can harden into emotional numbness. We depersonalize patients not because we’re cold, but because we’ve run out of bandwidth to carry the weight of every story. Cynicism grows when systems repeatedly fail us, or our patients. And perfectionism, so often rewarded in training, can calcify into rigid control when faced with uncertainty. These aren’t fixed personality traits; they’re defenses constructed under duress.

The encouraging part is that, because these traits emerge in context, they can also soften or reverse in the right setting. The research is clear: When training and working conditions improve, people change. When stress decreases, empathy returns. When physicians are supported, not shamed, for having limits, they begin to cope more flexibly and humanely.

Interventions that help include building resilience and emotional regulation skills, incorporating trauma-informed perspectives into both patient care and clinician self-care, strengthening collaborative and psychologically safe work environments, and carving out real space for reflection and mindfulness. These aren’t gratuitous perks or luxuries; they’re antidotes to cultures that ask young physicians to armor up before they’ve had a chance to form healthy habits of mind.

Medicine is not unique in this regard. Lawyers, police officers, and other professionals working under chronic stress display similar patterns: What looks like personality change is often accumulated defense. The job doesn’t fundamentally alter who we are; it shapes how we survive.

Which brings us back to Danny Reagan. When an officer asked whether police work had turned the watch group leader into a racist, Danny didn’t hesitate: “He just wasn’t the man for the job.” His point wasn’t that character is destiny, but that professions reveal our inner scaffolding. Under pressure, some structures bend; others crack.

Assimilating the virtues of a profession (discipline, decisiveness, composure) is a good thing. Letting the job warp our relationships, or turn us into people we no longer recognize, is not. The responsibility is two-fold: professions must reform the conditions that produce maladaptive defenses, and we as individuals must remain vigilant about the stories we tell ourselves to justify behavior that doesn’t reflect who we want to be.

In the end, the goal isn’t to avoid becoming an “asshole doctor.” It’s to understand, compassionately and honestly, how the culture of medicine shapes us, and how we can choose to reshape ourselves.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.