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Day 4: Reflecting on Social Conditioning

Being a physician comes with public expectations, and we place them on ourselves. We’re held to high standards in our professional communication and personal lives. While these high expectations can drive personal growth, it’s essential to recognize how they influence our behaviors, decisions, and self-care.

What are the expected traits of a doctor? 

After doing some research, I compiled this list:

1. Compassion
2. Strong work ethic
3. Ability to master emotions and stay calm in any situation
4. Excellent, up-to-date medical knowledge
5. Self-discipline
6. Confidence
7. Presence and patience
8. Respect
9. Optimism
10. Quick learner and adaptability to ever-changing circumstances

Consider these traits. Do they come naturally to you? Do you embody them in every circumstance, at every moment? Probably not all the time, because as much as we strive to be professionals, we’re also human.

Now, let's talk about our human nature. We are born from one cell and evolve into approximately 724 trillion cells, with around 37,000 billion billion chemical reactions occurring every second in our bodies. We have 86 billion neurons communicating via chemical messengers.

Like everyone else, we have both a biological body and a psychological self—whether you call it personality, identity, or ego, the label doesn’t matter.

In simple terms, burnout is a state of imbalance within the body, similar to any disease. This imbalance happens due to chronic stress. Chronic stress activates the HPA axis, releasing corticotropin-releasing hormone in the hypothalamus, which stimulates the release of ACTH, leading the adrenal glands to produce cortisol.

Cortisol mobilizes energy in the form of glucose for immediate use by the muscles—priming you for fight, flight, or defense. It shifts the body into a catabolic state, withdrawing energy from your "energy accounts." If this process continues without replenishment, you run out of reserves, just like depleting your bank account—leading to what we call burnout.

The stress response itself isn’t the problem; it’s a survival mechanism. The issue arises when it’s triggered not just by physical threats but also by psychological ones, such as unmet expectations.

Publicly, it’s often expected that you maintain all the personal qualities of a physician 100% of the time. When you fall short of these expectations, it can feel like a real threat, triggering the same HPA axis response. Physical threats usually cause a short-term stress response, but psychological threats can result in chronic, maladaptive stress, which leads to burnout.

The Hidden Burden of Meeting Expectations:

1. Compassion – Constantly sharing in patients' suffering (emotional and physical) activates your brain’s mirroring neurons, which can trigger a stress response. Overuse of these neurons leads to compassion fatigue, a major symptom of burnout.
2. Strong Work Ethic – A strong work ethic often means ignoring your body’s signals to rest. Over time, this leads to physical exhaustion, another key symptom of burnout.
3. Mastering Emotions – Constantly staying calm and composed requires the release of neurotransmitters like GABA to counter stress. Over time, depletion of GABA can cause irritability, frustration, and anger—signs of burnout.
4. Up-to-date Knowledge – In today’s fast-paced medical landscape, staying up to date is challenging. Trying to do so while under stress can contribute to chronic stress and burnout.
5. Self-discipline – While self-discipline drives success, pushing through without rest, even when your body needs it, is a recipe for burnout.
6. Confidence – Doctors are expected to remain confident, even in situations beyond their control. When you can't share your worries or doubts, you end up wearing a "mask of confidence," adding to your stress.
7. Presence – Physicians are expected to be fully present with their patients, listening to their concerns. However, with staffing shortages and overwhelming administrative duties, this expectation often doesn’t align with reality, contributing to burnout.
8. Respect – You’re expected to maintain respect and composure, even in situations where you're blamed or mistreated, which can be emotionally draining.
9. Optimism – While optimism is important, the pressure to always project positivity can lead to internal conflict and covered-up emotions, which can worsen stress.
10. Quick Learner and Adaptability – While doctors are quick learners by nature, the constant adaptations required in a healthcare system ruled by insurance companies and administration, rather than patient care, can feel demoralizing. Being forced to adapt to values that conflict with your own can be exhausting.

Striving for excellence and raising your standards is important, but it’s also necessary to recognize how public expectations influence your self-image and health choices. Could these expectations be creating internal conflicts or adding pressure to behave in ways that are stressful for you?