When I think about the defining trait physicians have, it is perseverance. Persistence in doing something despite difficulty or delay in achieving success. We work hard to get into medical school. If you do not get accepted the first time, you double down. You apply to more schools, take a course for the MCAT, brush up on interview skills, and pad your resume with more research. You explore less traditional paths. And you finally get in.

If you have not already been humbled along your academic path up to this point, medical school will take care of that. The volume of material is immense. You are surrounded by other high-achieving, persistent people. It is a whole new level of competition. I had a friend from an Ivy League school once tell me she could not understand why she was struggling so much while someone like me was doing well. I imagine that was quite the humbling experience for her. I was humbled when I got an F on a test. Most of the class did poorly, but still, this was a first for me. That moment sticks. And if medical school does not humble you, residency certainly will.

Who becomes a doctor?

So who is the person that pursues medicine? High achievers with grit and endurance. People who accept the challenge, struggle at some point, and keep going. We push through to reach the goal. We are reminded often: It is a privilege to take care of people. And it is. But what is not talked about is how deeply we are conditioned in the process of becoming a doctor.

In med school, most of us stayed in the zone, eyes on the prize. We rotated through primary care offices, hospitals, and nursing homes. We met a wide range of attendings, some amazing, and some were not. During my schooling, we did not talk about self-care, getting adequate nutrition, getting enough sleep, or managing stress. No one was asking us what resources we needed. Everything was about exams, performance, and figuring out what specialty we wanted and how to land a spot.

My friend group became mostly med school friends. Those outside medicine could not really understand what our world was like. The studying. The pressure. The requirements. The hours. Many of my peers had finished college and were working already, generating incomes and saving for retirement. We, on the other hand, were paying to be there. To be taught, yes, but also, sometimes, to be ridiculed for not knowing. For the simple act of being a student.

Still, I actually enjoyed med school. I was happy to be there, happy to be learning the knowledge I needed, and getting closer to being a doctor. The last test I took in med school felt surreal. My friends and I were excited for graduation and what was coming next. I did not think much about my needs at all during that time. My identity was completely wrapped in achieving this dream. I was too busy doing the damn thing.

The hidden curriculum

Let us talk about med school just a bit more: third-year rotations, the real immersion into medical culture. On the first day of my surgical rotation, scheduled on New Year’s Day, our attending had us at the hospital before dawn. He was notoriously famous for asking impossible questions and raking you over the coals if you did not know the answer, a practice what we call “pimping.”

We met in the doctors’ lounge, me and two of my male classmates. He came in, older and curmudgeonly, told us what to expect, and then took us to round in the ICU. One of his patients had a perforated bowel with an ostomy. He told us: “Never let the sun set on a virgin abdomen.” He meant that you operate fast on certain emergencies. After seeing just two patients, he turned to us and said: “You guys can go. I just wanted to put hair on your chest.”

It was a rite of passage. A weird little hazing. That moment stuck too. That is how it generally was: The older docs showing the incoming docs the “reality” of medicine. There was a kind of hierarchy built on endurance and unspoken rules: I had it this bad, so now you must too.

That style of teaching, public shaming, being made an example, and humiliation if you did not know the answer, was common. It was never said aloud, but the belief seemed to be: Shame will motivate you. If it hurts enough, you will study harder. Next time, you will have the right answer. It was as if shame were the best teacher and humiliation built better doctors. Spoiler: It did not. It just built doctors who were very, very good at looking fine.

Some of that is changing. But the toxicity still lingers. It gets passed down like generational trauma. We do unto others what was done to us. And all of it is part of the conditioning. Not just to know medicine, but to become worthy of practicing it. We learned to endure. To push through.

The missing curriculum

The medical system conditioned us to see pushing through as virtue. To view our needs as weakness. To believe that if we could not handle it, we did not belong. We were taught that we were doing something wrong. We were never taught that having needs is human, not weakness. We were not taught that boundaries were not betrayal, or that choosing ourselves was not the same as abandoning our patients.

Systems benefit from the resilience narrative

When we do not honor our needs and limits, we are set up for depletion. We have no problem teaching our patients about the importance of self-care, stress management, and advocating for their own health. The problem is that we do not apply it to ourselves because we were taught that our job requires us to push beyond our needs.

And systems have learned to count on that. When a physician struggles, the onus is placed on them to build more resilience, which conveniently keeps the system off the hook. Burnout becomes a personal failing rather than evidence of a broken structure. The path forward is not more endurance, but unlearning.

• For the individual physician, the unlearning involves recognizing that sacrificing our own health is not part of the job.
• For the health care systems, the unlearning requires realizing that dependence on altruism is not a sustainable operating model.

We do not need to learn to tolerate more. We need medicine to be humane.

Lisa Rubiano is an internal medicine physician.