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Clinicians are pushed to do more with less, until many quietly conclude they are not enough. J. C. Sue, a family medicine physician and adjunct faculty member, returns to unpack where that belief comes from and why it does so much damage across medical school, residency, and practice. You will hear how the business side of medicine and a competitive training culture teach doctors that they must be perfect, why serving beyond your real limits leaves patients, employers, and clinicians all worse off, and what a healthier reframe sounds like: you are human, not infinite, and that is enough. Hsu also walks through how to recover after an inevitable mistake, from acknowledging the feelings to separating human error from a faulty system to giving yourself grace. This episode is based on his article “Medical mistakes happen and you are still enough,” published on KevinMD. You will come away with a kinder, more honest way to talk to yourself when medicine asks for more than any one person can give.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back J. C. Sue. He’s a family medicine physician. Today’s KevinMD article is “Medical mistakes happen and you are still enough.” J. C., welcome back to the show.

J. C. Sue: Yeah, thank you, Kevin. It’s great to be back. I know it’s been a while.

Kevin Pho: Yeah, it’s been a few years. And for those who may not remember you, just give us a little bit of background about yourself, and then jump right into why you decided to share this particular article on KevinMD.

J. C. Sue: Yeah. So, I’m a family medicine physician, as you said, and previously, when I’ve been on the podcast, I’ve shared insights about medical music because I am a musician as well, and I write songs to explain medical concepts for medical trainees, and I do that through my online business, TuneRx.

So, I decided to share this article because beyond helping people learn, really what I like to focus on is helping people stay well during their medical training because I’m sure, as we both know, the system can be very stressful. And even though we know there’s a definite end to the journey, it’s very tough along the way.

So, this article I submitted to you was actually one of my website blog posts, and it was inspired by a talk I heard at a medical conference I attended just a few months ago. So, as I mentioned in the article itself, the speaker said something along the lines of the system essentially expects us, as physicians and other health care workers, to keep doing more and more with sometimes even having less resources than we had before. And we can easily come to tell ourselves or think that we are not enough.

And then the speaker said, “When we say we are not enough in that context, really what we mean is we’re not infinite, but we’re not meant to be.” So, I thought that was refreshing to hear and definitely an important point to consider, especially as a family physician, where I’m trained to do a little bit of everything essentially.

Kevin Pho: How did it get to be this way? Why do you think medicine so often makes clinicians feel they have to be perfect, that they have to do more and more, and that makes them feel like clinicians aren’t enough? How did we get to this point?

J. C. Sue: I think there are multiple factors that contribute to this. Overarching, I think, is the fact that these are the social norms in medical culture that we’ve come to accept today, and I think part of it was that just in the past few decades insurance companies got very big, and because many of those people have backgrounds that are more oriented toward business rather than patient care, there tends to be some disjunction between what a businessperson’s priorities are and what a clinician’s priorities are.

As a result, clinicians may often feel pressured to see more patients in less time so that they can generate more money for their company, or if they’re in private practice and taking commercial insurance themselves, so that the lights can stay on, the doors can stay open. And from what I understand, unfortunately in many corporate medical environments, much of the money actually doesn’t really go to the doctors. It goes to the hospital CEOs, the insurance companies, other administrators, et cetera.

Aside from that, I think this, at least for doctors, also starts in medical school because there’s a very competitive environment, so you’re always expected to do something more to make yourself stand out, and because that becomes the norm, that easily gets carried over to residency and beyond.

Kevin Pho: Yeah. So one of the things that I say whenever we talk about that tension between the backgrounds of administrators and CEOs versus physicians is that administrators, they do not take the Hippocratic Oath. And that, I think, is the basis for that underlying tension between their motives and the motives of physicians.

Now, you’ve been, of course, practicing for a bit now, and one of the things that you mentioned is that medical students in training or in early residency, they may not be exposed to some of these business aspects that our profession faces. So what are you seeing from a training standpoint, or are you in contact with those in training? Maybe they’re not exposed to some of the business aspects of medicine that makes medicine less ideal than it should be. What are you seeing from your end?

J. C. Sue: Well, so actually, yes, I am in contact with some people in training because I’m also an adjunct faculty member at Burrell College of Osteopathic Medicine. And because I only teach preclinical students right now, really I tend not to touch as much on the business aspects of things directly.

But from what I’ve observed both from my own medical training experience, which was within the last decade, and the training that I see today, well, I think that more and more training programs are starting to introduce the business aspects of medicine a little earlier than they used to. Even when I was in training back in the late 2010s, well, there was already a little bit of introduction to that in my second, third years of medical school and beyond. And certainly in residency we did have some academic talks from time to time from faculty members about how to code correctly, how the billing works, et cetera.

So I think that it is something that people are seeing more directly, at least by the time they get to early residency, if not sooner.

Kevin Pho: So your message in this KevinMD article was, “You are enough.” Why is that such an important message during medical training? And how are you, as a faculty member, how are you transmitting that message to the students that you teach?

J. C. Sue: Yes, I think that’s an important message because realistically we can’t be expected to serve beyond our own personal capabilities. We can expand those capabilities sometimes as we continue to learn over the years and practice so we get better, but no matter what our capabilities are, if we try to serve beyond them, then we will fail and then nobody wins in that case because patients feel let down, coders aren’t happy with us. Maybe if we work for a hospital, they’re not happy with us because we’re not being productive enough in their eyes, and then we feel inadequate ourselves.

Yet if we are clear about what we can do for patients and for other people, then we can set expectations early that are realistic. And then with all our contributions combined as a whole health care community, we can work together to provide much more effective health care than any of us can provide individually.

As a faculty member, I really try to emphasize wellness to the students. You know, I make sure that they know that they can reach out to me through their school email if they have any questions about anything, even if it’s just a mentoring sort of question or career planning question. And I also try to lead by example in my own practice. You know, I definitely try to be clear about these sorts of things through any blog posts that I put out, and also make sure to stay within my own limits as a clinician and have a life outside of medical practice.

Kevin Pho: One of the things that I talk with other guests about when it comes to self-compassion and burnout during medical training was that sometimes in medicine, and it starts very early on, a lot of future doctors are discouraged from showing vulnerability. They’re discouraged from asking for help and reaching out.

Now, what are you seeing with today’s students? Are people taking you up on that offer and reaching out to you if they need help, or asking you for advice when it comes to self-compassion? What are you seeing in today’s medical students?

J. C. Sue: From my experience, I see that sometimes when I give people the opportunity to ask any questions they want, some of them do ask. I haven’t had a lot of follow-up outside of that, but every so often there may be someone who does reach out there. I think that slowly the culture is shifting in a favorable direction. It’s just going to take time because as psychologists have found, social norms develop over decades, even centuries, so they take a long time to fully change.

Kevin Pho: Now, one of the other things that you wrote in your article was moments that may trigger shame. How should clinicians talk to themselves, or what should they do after these inevitable events happen? Because it does happen to every doctor. What are some pieces of advice that you could share after these events?

J. C. Sue: Well, I think that an important part of recovering from that event is taking time to acknowledge the feelings that you experience, because if you don’t do that, then that’s essentially ignoring the issue, and then nothing will change.

Another component that I think is important is figuring out why the issue occurred, and sometimes it could just be an inadvertent human error that happened because none of us are perfect. Other times, there may be some sort of systemic process that is faulty and therefore making people more prone to make that type of mistake, in which case then that systemic component should be fixed as much as possible.

So I think those things are important and along with that, I would say that people should see what they can learn from the experience, of course, when they have processed it and are ready to mentally do that.

Kevin Pho: One of the lines in your piece was very powerful. It was this: “I am human, and I am enough.” What do you hope listeners would take away from that phrase?

J. C. Sue: Well, that phrase was actually a direct quote from the speaker, and I wrote it down because, as you said, yes, it was very powerful, so I wanted to pass that on to other people. I think that message is important because those of us who go into medicine have to remember that just going into medicine does not automatically give us some sort of superhuman status, because we still have our own human needs and our own human limitations.

We have simply stepped into a role in which we can be in a unique service position to others. And I think it’s important to remember that we are still human so that we don’t place unrealistic expectations on ourselves and, as a result, beat ourselves up unnecessarily.

Kevin Pho: We’re talking to J. C. Sue. He’s a family physician. Today’s KevinMD article is “Medical mistakes happen and you are enough.” J. C., as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.

J. C. Sue: Yes. So, some take-home messages from me would include accept that mistakes will happen, but trust that no one mistake has to define your whole career if you don’t want it to.

Another would be remember to treat yourself as your own best friend. You know, make sure that when a mistake happens, you see what you can learn from it, but also give yourself grace so that you can move forward and do things better in the future.

And finally, I would say make sure that no matter what happens, take care of yourself. Nothing in medicine, like the rest of the world, will be perfect, but you can always take care of yourself and try again the next day.

Kevin Pho: J. C., thank you again for sharing your perspective and insight. Thanks again for coming back on the show.

J. C. Sue: Thank you, Kevin. It’s been a pleasure.