Superhuman vs. Shame

he concept of what it means to be an “ideal doctor” has been reverberating through my mind throughout residency. I’ve looked to my own physician role models and seen elements I’d like to emulate and ones I’d like to do without. The themes discussed in this episode of The Nocturnists [Ep. 2 “The Ideal Doctor”] of ideals of endurance, self-expression, and altruism and where they come from mirrored many of the ideals with which I’ve wrestled. Listening to these stories, I felt sadness for the experiences of these healthcare workers and a profound understanding of their plight.

Just a few weeks ago, I had COVID myself and had to quarantine at home for a week. Listening to the story of the first resident, having to see patients and then suddenly needing 2 liters of fluid, epitomized that entrenched feeling of “I have to keep going. My patients and my co-residents need me.” Though I was met with unconditional support by my co-residents and department, the guilt and anguish of feeling like I shouldn’t have gotten sick persisted longer than any symptoms of the disease itself. This ideal of being superhuman and always oriented to serving others is a potent driver of intense shame experiences.

The challenges of being under constant critique and in high stress situations – as in the stories of the medical student Joy and the unnamed surgical PA – is a hallmark of medical education. For Joy, receiving constant feedback that she is “hard to read” and “not engaged” were proxies for not fitting a model of a certain type of student. I believe this model is formed by those who have been part of the majority group in medicine, and as we intentionally diversify the student body, we must have even more intention to break down that model and widen the umbrella for all manner of student expression.

The final two perspectives of this episode mirrored deep-seated feelings I’ve had during training. From the doctor who was inspired by her father, a small town doctor, suddenly finding herself in a maelstrom of career goals and expectations that didn’t match her values to the student reading through a list of traits he could never achieve, the throughline of “I don’t think I belong here” is a major driver of shame. I’ve had that thought countless times, even on the first day of medical school. I remember thinking I’d look down at the sign-in sheet on the first day and not find my name, knowing that my acceptance was a huge mistake. This feeling has needled its way into each phase of my medical training, though now being met by the evidence of patients who enjoy the care I give them.

I imagine many of these emotions and experiences won’t leave us as we move through careers in medicine but knowing that these are shared experiences helps us break down the silos between us. Additionally, I see them as signals as moments to rest and consider where we are going and who we are becoming, with the hope that we can live out the values that brought us to medicine in the first place.