If you have ever served in the military or have seen the movie "Full Metal Jacket" then you know the depth of conditioning that happens in becoming a soldier. Soldiers are conditioned to walk into situations where everyone else is running out, on a simple order. They are trained to ignore every natural emotional and physical instinct that protects them from harm and walk into live fire and across dangerous mine fields. And they are trained to do all of this in most cases in less than 12 weeks. Of course their skill level is increased over time, but the mindset conditioning happens in a matter of weeks inside their boot camp.
As physicians, we are not very different from soldiers. We are conditioned to run to situations that most avoid. We deal with highly charged and emotional situations with patients. We are trained to ignore the basic physical sensations of hunger, a full bladder, and exhaustion; and we are trained to suppress our natural emotional responses in order to maintain authority, the appearance of strength, or simply to "get through the day."The biggest differences between soldiers and doctors is this: Most physicians are not walking constantly into physically dangerous battlefields daily (although our battlefields are usually mental/emotionally harmful), and our conditioning is continuous.
From the moment we enter medical school our indoctrination begins. It's as if we have entered into some longitudinal pledge process in which the hazing lasts for at minimum 4 years (and for some who go into surgical and some subspecialties longer). We are led down a path all the while being fed subtle subconscious messaging.Think back to when you were in medical school: How many times did you ASK your resident or attending if you could go to the restroom?If they said "No, or wait until after rounds" then as a medical student (and even an intern) you'd do just that, correct?Sometimes they'd say yes, but with obvious disapproval. And sometimes they would even dramatize things with a story or a riddle about how good doctors could hold their bladder for hours…or how you should "manage your water intake" next time.The messaging here is obvious. Ignore your own bodily functions and put the patients first.I have experience similar interactions with having pain, or needing to eat and sleep.Slogans like "Sleep when you're dead" and "Pain is just weakness leaving the body" or even "Eat when you can, sleep when you can, pee when you can, and don't mess with the pancreas…" are quintessential messaging that has been ingrained into the deepest fibers of our being. What seemed like funny and quirky saying back then have become the very conditioning that is leading doctors to burnout within 5-10 years of practice today.
Furthermore, this conditioning presents fatal consequences when the doctor feels like "they can't handle the pressure" and has no other options.There is a scene I often somberly remember in the movie "Full Metal Jacket" where the Private Gomer Pyle is found up in the middle of the night with his rifle and a full mag.Though Private Joker (who had been assigned his personal tutor) tries to subdue him, it was evident that the damage had been done. The physical and emotional abuse he had suffered from both his Sergeant and his unit had him pushed him beyond the edge. In that scene when provoked by Sergeant Hartman about why he is up in the middle of the night, he shoots the Sergeant and then subsequently takes his own life.
When we ignore our physical, mental, emotional and spiritual needs… when we are mentally and emotionally abused by the system (and all that it includes). When we pour our heart and soul into our work and are not appreciated by our patients…. We are pushing ourselves to that edge.We keep telling ourselves we are okay when we are not until we are Private Gomer Pyle up in the middle of the night in the bathroom with a full metal jacket and a rifle.
The bottom line is this. We must acknowledge and understand our conditioning if we are to ever move past the state of "victimhood" that we have embraced, and move into a place of empowered action. How we do that is by becoming open to solutions that would shine the light on these processes and commit to undoing them. For example therapy can be an effective tool for recognizing and overcoming the limiting thinking that comes with our conditioning. Physician coaching is another service that when utilized regularly can be very effective in undoing the indoctrination and sparking empowered action toward new burnout solutions.
There is an old John Wayne quote that says "Sometimes it isn't being fast that counts, or even accurate; but willing."If we are willing to step outside of the box that the conditioning has placed us, then we have a chance at dismantling the conversation not just for ourselves but for the generations of doctors to come.
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