How Do You Feel?

1. Medicine's Culture Suppresses Emotion and Vulnerability.

“There’s no crying in medicine,” she almost whispers.

Stoicism is taught. From medical school onward, healthcare professionals are implicitly and explicitly taught to suppress their emotions. Witnessing death, suffering, and chaotic emergencies without showing a reaction is often modeled and rewarded, while displays of sadness or vulnerability can be seen as weakness or unprofessionalism. This creates a culture where feelings are unwelcome.

Emotional regulation is learned. Doctors and nurses learn to compartmentalize or detach from their feelings to cope with the intensity of their work. While this can be a necessary short-term survival mechanism in high-stress situations, it can lead to long-term emotional numbness, difficulty identifying one's own feelings, and a disconnect from the human aspects of the job.

Feedback reinforces suppression. Negative feedback or judgment from supervisors and colleagues for showing emotion further cements the idea that feelings are unacceptable in the workplace. Stories circulate about those who were labeled "soft" or had their abilities questioned because they struggled emotionally, reinforcing the pressure to hide one's true feelings.

2. The Pandemic Intensified Healthcare Worker Burnout and Trauma.

Work is like a rude awakening, and I just keep thinking, Oh, my God. This is our new normal.

Unprecedented stressors. The COVID-19 pandemic introduced a new level of chronic urgency, exposure risk, and moral distress for healthcare workers. Redeployment to unfamiliar units (like ICU for oncology nurses), inadequate training for new roles, and witnessing mass death and suffering became commonplace, overwhelming existing coping mechanisms.

Exacerbated existing issues. The pandemic didn't create burnout or trauma in healthcare, but it significantly worsened them. Pre-pandemic burnout rates were already high (up to 50%), and PTSD in nurses exceeded that of wartime veterans. The constant exposure to death, coupled with feelings of helplessness and moral conflict (e.g., reusing masks), pushed many to their breaking point.

Physical manifestation of stress. The chronic, overwhelming stress of the pandemic manifested physically in healthcare workers. Symptoms like persistent fatigue, difficulty concentrating, increased anxiety, and even physical reactions like elevated heart rate or shortness of breath became common, often signaling burnout or trauma responses like PTSD.

3. Seeking Mental Health Help Faces Deep Stigma in Medicine.

“I feel like I’m not sick enough to be out of work,” Luke continues.

Internalized shame. Despite high rates of distress, healthcare workers are often reluctant to seek mental health treatment due to internalized shame and fear of judgment. They worry that needing help signifies weakness, lack of resilience, or being "not cut out" for the job, especially compared to colleagues who appear to be powering through.

Fear of professional repercussions. A significant barrier is the fear that seeking mental health care could negatively impact one's career, from residency applications to state licensing. While laws exist to protect against discrimination based on past mental health issues, the perception and reality of intrusive questions on licensing forms or biased evaluations persist, discouraging many from getting needed support.

"Sick enough" is a moving target. The culture of presenteeism in medicine sets an impossibly high bar for what constitutes a legitimate reason to take time off. Stories of colleagues working through severe physical illness or personal crises reinforce the idea that one must be "dead" to stay home, making it even harder to justify taking leave for mental health struggles, which are often invisible or dismissed.

4. Identity and Self-Worth Are Dangerously Tied to Achievement.

What I wanted to be was perfect.

Achievement as validation. Many individuals drawn to medicine are high-achievers who have long tied their self-worth to academic and professional success. Grades, test scores (like the MCAT or Step exams), and career milestones become the primary metrics of value, overshadowing emotional well-being or personal fulfillment outside of work.

Fear of failure. The intense competition and high stakes in medicine cultivate a deep-seated fear of failure. Making mistakes, receiving negative feedback, or not meeting perceived standards (even self-imposed ones) can trigger intense self-criticism and feelings of inadequacy, reinforcing the pressure to appear perfect and avoid vulnerability.

External validation sought. The constant pursuit of achievement is often fueled by a need for external validation. Praise from parents, mentors, or colleagues reinforces the behavior, making it difficult to prioritize self-care or acknowledge struggles when they might be seen as counter to the image of a competent, successful professional.

5. Empathy and Connection Are Vital, Yet Emotionally Costly.

“It is both a blessing and a curse to feel everything so very deeply.”

The cost of caring. Empathy is a crucial trait for healthcare professionals, enabling connection with patients and providing compassionate care. However, in a field constantly exposed to suffering, trauma, and death, feeling deeply can be emotionally exhausting and lead to secondary traumatic stress or vicarious trauma.

Protecting oneself. To survive the emotional toll, healthcare workers may unconsciously distance themselves or tamp down their empathy. This can manifest as emotional numbness or a decreased desire to connect with patients on a personal level, which conflicts with the core value of helping others and can lead to feelings of guilt or a loss of meaning.

Patient connection matters. Despite the risks, genuine connection and empathy from healthcare providers are highly valued by patients. Patients report higher satisfaction, better outcomes, and feel more seen and cared for when their doctors and nurses show their human side, even if it means occasionally showing emotion like crying.

6. Individual Coping Isn't Enough for Systemic Problems.

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.

Self-care is not a cure-all. While individual coping strategies like mindfulness, journaling, or therapy are valuable tools, they are insufficient to address the systemic issues inherent in healthcare. Promoting self-care without addressing toxic workplace culture, inadequate staffing, or lack of support places the burden of well-being solely on the individual.

Systemic issues are pervasive. Problems like chronic understaffing, moral injury (being forced to act against one's values), lack of administrative support, and a culture of silence contribute significantly to healthcare worker distress. These issues are deeply ingrained and require organizational change, not just individual resilience or coping skills.

The "leaky boat" analogy. Trying to cope with systemic problems using only individual strategies is like bailing water from a leaky boat without fixing the leak. You might temporarily feel lighter, but the underlying problem persists, and you will eventually become overwhelmed again. True well-being requires addressing both individual needs and systemic flaws.

7. Finding Meaning and Setting Boundaries Are Essential for Survival.

“But for you, the yolk is just oozing all over everything.”

Work can consume life. In medicine, the demands of the job (the "yolk") can easily expand to fill all available space, crowding out personal life, relationships, hobbies, and rest (the "egg white"). This overcommitment, often fueled by a desire to help or achieve, leads to burnout and prevents recovery.

Saying no is necessary. Learning to set boundaries and say no to additional demands, even prestigious or seemingly helpful ones, is crucial for protecting one's capacity. This is challenging in a culture that rewards overwork and where saying no can feel like failure or missing out on opportunities.

Finding meaning sustains. Connecting with the inherent purpose and meaning in healthcare work can be a powerful buffer against burnout. Reflecting on positive patient interactions, celebrating small wins, and remembering why one entered the field helps sustain motivation and provides a sense of accomplishment even amidst difficult circumstances.

8. Authenticity and Self-Compassion Drive Healing and Change.

Crying does not indicate that you are weak. Since birth, it has always been a sign that you are alive.

Hiding hinders healing. Suppressing emotions and presenting a curated, perfect image prevents genuine connection and hinders personal healing. Sharing one's struggles, even if uncomfortable, can be a powerful act of authenticity that normalizes mental health challenges for oneself and others.

Self-compassion is vital. Perfectionism and the culture of medicine often lead to harsh self-criticism. Learning to treat oneself with the same kindness and understanding offered to a friend is essential for counteracting negative self-talk and fostering emotional well-being, especially after perceived failures or mistakes.

Vulnerability fosters connection. Sharing personal experiences, like being in therapy or on medication, can break down stigma and build trust with patients and colleagues. While the decision to self-disclose is personal and carries risks, it can demonstrate humanity and make others feel safer to seek help themselves, driving cultural change from within.

9. Hope and Support Are Critical in a Broken System.

“Those who have a why to live can bear with almost any how.”

Hope is action-oriented. Hope is not just passive optimism but an active belief in the possibility of a better future and the agency to work towards it. In overwhelming situations like a pandemic or a broken system, focusing on what can be controlled and taking small, actionable steps helps cultivate hope.

Support is a protective factor. Feeling supported by supervisors, colleagues, friends, family, and mental health professionals is a critical buffer against distress. Knowing you are not alone and that others care provides strength to navigate challenges, even when systemic issues remain unresolved.

Small changes matter. While large-scale systemic change is slow, individual actions and small shifts in culture can have a significant impact. Normalizing conversations about mental health, offering a moment of support to a struggling colleague, or simply asking "How do you feel?" with genuine care can make a difference in a field where such gestures are rare but deeply needed.

Last updated: May 19, 2025