A Culture of Care

Not a week goes by that I'm not contacted by a doctor or medical student who is thinking of leaving medicine. What's going on? Are all these people simply failing to "cut it" in a tough profession?

It's no secret that you have to be a high performer in order to make it into medical school. You not only need to show excellence in your studies, but also demonstrate strong leadership qualities and a track record of participation in numerous extra-curricular activities.

How is it then, that years down the line you get to a point of wanting to throw in the towel? What happens to those bright-eyed-and-bushy-tailed young people such that they end up disillusioned and ready to leave it all behind?

This is where culture is key. All too often the people who reach out to me describe the same experiences: feeling as if each day is a battle to survive; a sense of being powerless to effect change; feeling like they are simply cogs in the patient-processing machinery.

If these experiences were isolated we could chalk it up to a mismatch between the individuals and their chosen profession. However, when these sentiments are expressed repeatedly, not only in conversations with me but also on various platforms that cater specifically to burnt-out and disillusioned doctors, you have to look further than the individuals who speak up. Their experiences are symptomatic of a broader systemic issue, and culture plays a key role in that system.

I think this is part of the reason why it's often so difficult to effect meaningful change. You can establish protocols and improve processes, but changing culture demands more than a technical skill set. It requires leadership.

Leaders are custodians of culture, and in a profession as old as medicine they are custodians of a long-standing tradition of how things have always been done. As much as there is much to admire in this noble profession, there is also a lot that isn't working and hasn't worked for a long time: a culture of fear and intimidation, of toxic rivalries and competition, and where the number of qualifications you have and papers you've published trumps the quality of your character as a human being.

What is it going to take for doctor leaders to help bring about a shift in culture, where caring for and about each other is as important as delivering quality patient care?

  • A willingness to take an honest look at the impact of culture on the (dys)function of the institutions and teams they lead.

  • The humility to let go of some of the "toxic perks" that come with being in a leadership role, e.g. the "entitlement" to treat juniors poorly or to be disrespectful towards nursing staff.

  • The courage to care and to show that you care; to acknowledge your mistakes; to learn new ways of being and to ask for help when you need it.

Culture takes generations to entrench. It's up to this generation of leaders to begin to chip away at its foundations so that in time there is a new way of doing things in medicine. Otherwise, the exodus will continue unabated.

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