My generation of physicians is entering the field at a historic moment. Covid will likely follow us through our careers.
The transition from medical student to physician, even in normal times, is a profound one; Covid-19 projects a whole new improbability to this moment. I graduated from medical school early to briefly join the ranks of New York City frontline workers in April, as the pandemic reached its peak. I had dreamed of being a doctor for more than half my life, and as a college student volunteering in a hospital, I conjured up gallant stories of my first weeks as a physician. Instead, Covid-19 ruthlessly dashed my expectations.
The gravity of this moment is now starting to sink in as the majority of medical residents start their training on July 1. I’m among a class of more than 35,000 other newly minted physicians who are entering hospitals across the country this summer amidst the worst global pandemic in over a hundred years. It’s not lost on us that we sit on the precipice of a major change in our lives during a critical moment in history.
Though it may seem unflattering to admit, I take some delight in joining the medical profession in this historic moment.
Like everyone else, we are afraid. We are scared of getting sick or passing Covid-19 to a loved one; scared for our psychological health; scared for our educational trajectory. I fear my early residency training will prepare me more for a career in palliative care than in my desired specialty of cardiology. But of course, we are also motivated, energized, and eager to help.
There is no “normal” way to become a doctor. Nor is there a “right” time to make the transition from a naive student to a physician who is confronted by life or death decisions for their patients daily. Humility takes on a heightened significance for new physicians in hospitals. Our radical advances in medical technologies over the last century have provided little solace or tangible benefit in our fight against Covid-19. In fact, we have resorted to medieval plague eradication techniques, like social isolation and quarantine, to successfully combat this scourge.
My first venture into the hospital was a crash course in medical humility. I was confronted again and again by critically ill patients, and each time I had to wrestle with the basic truth that there was almost nothing to be done. Senior physicians and older residents reminded me of this as so many of my early patients died, but in the moment, their guidance offered little comfort.
Many doctors adapt to this enormous responsibility by developing a steely exterior, or worse, a god complex. My own experiences as a patient gave me early exposure to this open secret within the medical world. I imagine doctors believe such confidence and poise project well for their patients, but it’s often to a fault. My hope is that a silver lining will emerge from the pandemic: It’s harder for this culture of narcissism to persist when young physicians are being trained around such high death rates, or having to constantly confront medicine’s limitations. Perhaps this generation of physicians will usher in a new age of medical humility and leave the paternalistic patient-doctor relationship in the past once and for all.
But medical humility is not the only trait young physicians need. It is equally crucial that young doctors have the chance to bolster their competence and confidence by being able to help their patients. However, confidence comes out of experiencing medicine’s astounding capacity, not its constraints. Covid-19 has and likely will continue to rob us of this crucial confidence boost for some time to come.
The intensity of training during a global pandemic is undoubtedly a double-edged sword for young physicians.
After the SARS outbreak in Toronto in the early 2000s, one study showed health care workers had significantly higher levels of burnout, PTSD, and psychological distress, which lasted more than two years after the outbreak was contained. Similarly, residents who trained during the AIDS epidemic in the 1980s and ’90s reported not only high levels of lasting psychological distress, but also decreased autonomy, breadth of training, and trust in medical technologies. No studies from that era capture whether these early challenges influenced their practice patterns, or for how long. Based on conversations with physicians who trained during that time, my sense is the AIDS epidemic has been profoundly impactful on their careers.
One of my mentors often reflects on his medical training during the AIDS epidemic by citing Shakespeare’s St. Crispin’s Day speech: “We few, we happy few, we band of brothers.” For most of medical school, I had a tinge of envy and awe when I heard about the intensity of his training. Now, I’m experiencing it myself.
Though it may seem unflattering to admit, I take some delight in joining the medical profession in this historic moment. I am not alone among my peers and colleagues. In my stint as a junior physician during the height of Covid-19 cases in New York City, older physicians repeatedly said I would look back at this time as a highlight of my medical career. I believe they are correct, however, I don’t want to reminisce about my training with rose-tinted nostalgia as many older physicians do. Our Covid-19 response has been filled with misery and suffering, along with occasional moments of profound joy. I am proud to have played some small role in helping and humanizing my patients thus far, but I’m most excited to arrive at a place where our medical interventions become more nuanced and effective.
There is an interpersonal joy in becoming a doctor at this time as well. It seems there is an endless appetite for medical knowledge and expertise right now. I have been overwhelmed by the number of questions about Covid and epidemiology I have received in the last three months. I’ve also been surprised by the new weight my words carry. In seeing my friends and family take my theories about the prospects of a second wave and the speed of vaccine development as medical fact, I’ve realized I need to be prudent about how I discuss medical information. In the midst of a pandemic, communicating clearly has the power to change public behavior, health policy, and thereby save lives.
The intensity of training during a global pandemic is undoubtedly a double-edged sword for young physicians. On the one hand, I worry Covid-19 will rob us of the important early experience of witnessing the powerful capacity of medicine to do good. On the other, in training through this pandemic, a generation of young doctors might reject paternalism, embrace humility, and understand medicine does not just take place in the interaction between a doctor and a patient, but also in the development of a trusting communication between health care workers and the community-at-large. I remain hopeful that by training during Covid-19, my generation of young doctors will be expert communicators and public health advocates. This is our chance to be vocal in the face of injustice and uncompromising in advocating for the health of the population, particularly those most vulnerable.