Everyday Sacrifices

Becoming a physician is about making sacrifices. There are ways to mitigate, minimize, and tailor those sacrifices, but as a whole, they're unavoidable. We give up our 20's and in many cases a fair bit of our 30's to become a physician. We give up nights out partying or relaxing with friends to study, to do research or other projects, to spend long days at the hospital. We give up time with our families, or delay having a family, in order to complete our training successfully.

There's really no getting out of these aspects of medicine, they're inherent in the profession and its training.

However, we also want physicians who are willing to make additional sacrifices for the sake of their patients. Physicians who will forego a little income to provide a good service on a regular basis. Physicians who will make an extra call to get their patients the supports they need. Physicians who will stay a little longer at the end of the day for a patient in crisis. It's far too easy to phone things in in this profession, to our patients' detriment.

That said, medicine has a problem with indiscriminate sacrifice. Medicine tends to encourage and incentivize physicians giving more of themselves without considering what the sacrifice is for, or whether it is even helpful.

Two scenarios that have happened often enough jump out at me.

1) Blatant Benevolence

A play on the concept of conspicuous consumption, where people buy expensive things essentially for the sake of showing they can buy expensive things, blatant benevolence is the idea of doing something good because of the reputation it garners. The original concept was applied to mating preferences, but the term has broader applications. In medicine, that means staying late, coming in early, taking on an extra patient or doing some additional grunt work. The idea is that these actions show desirable qualities to colleagues and superiors.

The important point here is that with blatant benevolence, it's the perception resulting from the actions that matters, not the effect of the actions themselves. There are, of course, instances when coming in early, staying late, or taking on an extra patient is extremely helpful and especially at the trainee stage, most people are eager to take these opportunities to demonstrate their commitment or ability.

It's when these actions are not helpful that the profession runs into trouble. Students pre-rounding an hour before their shift starts when no one asks them to. Residents staying hours after their shift ends to watch over a patient who they've already ably handed over to the next team. Staff sticking around to handle tasks that would normally go to residents for their learning. These actions clearly show that the physician or trainee puts medicine first and foremost, but don't add value to their patients' care and could be taking opportunities away from others.

We're thankfully moving away from these pointless shows of sacrifice, but it's still very much a part of medicine. Maybe 1 in 5 trainees seem to engage in this sort of behaviour regularly, but just like with conspicuous consumption, those who do engage in it pull others with them moving forward. A decent number of trainees come in with the idea that they must show. Which brings us to the second scenario...

2) Extraordinary Actions in Ordinary Times

Physicians are the first and last line when it comes to healthcare. When something falls through the cracks, we're expected - and even have a legal obligation - to pick it up. Medicine has a lot of cracks, however, so things slip through regularly. And dutifully, physicians respond by giving up even more of their lives to help their patients.

These actions are essentially required in medicine. The notion is that these are unpredictable events and so it is up to physicians to provide the flexibility necessary to respond to them.

When the extraordinary happens on a regular basis, it's no longer extraordinary. It's no longer unpredictable. Yet physicians continue to react to these commonplace occurrences as though they're extraordinary and unavoidable.

A physician staying late once a month is totally reasonable. A physician staying late once a week is troublesome, but manageable. Yet when I see physicians - particularly residents - staying late multiple times a week, it's no longer about physicians sacrificing for their patients, it's now physicians sacrificing for a poorly-run system.

Worse, when the extraordinary does actually happen, physicians may not have the ability or willingness to make that extra effort. They're already pushed to their limits with their regular expectations. Very few physicians are truly indifferent to their patient's interests, but fatigue and burnout can mean important but non-critical tasks get delayed, ignored, or rushed.

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I heard an older physician remark recently that my generation of medical students doesn't know the meaning of sacrifice. Certainly, what my generation seems to prefer and tolerate differs from the expectations of some of our superiors. However, I don't consider that to be a negative. What we consider a worthwhile sacrifice needs to be refined. There are some sacrifices made by established physicians I never want to make. Yet there are other sacrifices these physicians tend to avoid that I'm eager to make. Recognizing that physicians are human, that they have their limits and in normal times should lead reasonably normal lives, we need to be smarter about what sacrifices we choose to make or to ask each other to make.