Can a Doctor's Self-esteem, Once Destroyed, Be Regained?

Neil Chesanow

Disclosures

January 27, 2016

Why So Many Doctors Lack Self-confidence, and How to Get It Back

Many doctors enter medical school and residency programs brimming with self-confidence, having spent their previous lives in college and high school at the top of their class. Yet when they leave, their sense of self-worth is often shattered.

"Med school completely destroyed my self-confidence," one doctor-to-be wrote. "I am constantly feeling stupid and worried about failing out."

Hers is one of many recollections recounted by family physician Pamela L. Wible, MD, who hosts physician retreats on career reclamation, in a recent Medscape article. To better understand what happens, Dr Wible surveyed 189 medical students. "I asked them to answer one multiple-choice question: 'How has medical school impacted your overall self-confidence and/or self-esteem?' Of the respondents, 42% reported an increase, 50% reported a decrease, and 8% noted no change. Medical students were then encouraged to share why."

For a minority of medical school students who reported a decrease in self-esteem in this survey, and for a minority of the hundreds of residents and practicing physicians whom Dr Wible queried in subsequent surveys, the overwhelming amount of information a doctor needs to know to practice good medicine, or the pressures of dealing with Medicare, insurance companies, and hospital or practice administrators, undermined their self-esteem. But for most respondents, the culprits were abusive preceptors, attendings, and fellow residents.

"I entered medical school so very confident in myself, and that was beaten out of me," one medical student confessed. "I was repeatedly told I was stupid."

"I had emotional whiplash in residency," a family doctor remembered. "Attendings would gang up on one resident and say, 'You're destined to fail. You're lazy.' I received scathing reviews about 'attitude' and 'difficulty with authority.' I remember standing in my bedroom having crazy panic attacks and thinking I could not go on."

"I encountered quite a few prejudiced, sexist, and terribly ignorant people" in medical school, an emergency physician recalled. "One day I challenged a male student regarding his response to a question, and he literally lunged over a table at me. A number of male surgeons sought to put me in my place, especially if I failed to be deferential. I spent a lot of time in tears and horribly lonely. It took years to rebuild my self-esteem, but owing to the long hours in emergency medicine, I've continued to struggle with loneliness."

"Our program director suggested we get 'slave' T-shirts for the group," an internist confided to Dr Wible. "In my residency mailbox, I even received nasty anonymous 'you're too fat' notes, with ads for diet pills attached."

"Of those who reported a decrease in self-confidence, their experiences often led to chronic mental health issues, including PTSD [post-traumatic stress disorder]," Dr Wible writes. To rectify such abusive situations, she makes the following recommendations in her article:

  • Stop institutional abuse (she urges medical students and residents to report it and stand up to it);

  • Seek mental healthcare (many doctors say they are depressed or anxious as a result of mistreatment; some are suicidal);

  • Build strong relationships (supportive relationships can help you through rough spots, Dr Wible advises);

  • Promote a culture of open communication and respect; and

  • Refuse to be a victim.

The article elicited scores of responses from physicians, the majority of whom recalled their own abuse in medical school, residency, and beyond, confirming Dr Wible's assertion that such confidence-eroding abuse is widespread in medicine.

"It has been a hard journey," a cardiothoracic surgeon agreed. "My medical school did nothing when I informed them of sexual harassment by a professor. I was told to take him out for a cup of coffee and let it go. One of the surgery professors discouraged me from pursuing surgery because he did not believe it was for women. Afterward, during job interviews, I was asked when I planned on becoming pregnant 'because you are attractive, and I fully expect you to start a family.' Or: 'You are attractive. Are you sure you know what you are doing?'"

"A surgeon recently talked about how he didn't even know he was a jerk until his hospital instituted a 360° feedback policy from all his coworkers," a psychiatrist observed. "He thought he was just behaving the way he was trained to do in residency. For decades, he treated every nurse, tech, resident, and med student like they were subhuman. Now, think of all of the other surgeons he did his residency with who have never gotten any feedback. They are all out there right now, treating everyone around them like garbage."

"As an academic for 10 years, I witnessed the bullying, insults, and demeaning attitude toward students and residents," an anesthesiologist confessed. "The culture is self-perpetuating and ingrained. Unless medical schools make a major concerted effort to change the toxic milieu, nothing will change."

"This article hits the nail on the head," a physician wrote. "I hope the medical community sits up and takes notice. Physicians are humans who feel, live, and breathe and must be healthy to keep our patients healthy. But many become emotionally crippled by medical school and residency. Nobody sits up and takes notice until someone becomes a victim of suicide, and even then, the blame is entirely placed on that individual. It is just so wrong."

"Thank you for starting a dialogue on medicine's dark secret," a general practitioner commented. "More light needs to be shed on the insidious and overt nature of sexism in the male-dominated/better-paid areas of medicine. In my experience, this manifested as everything from being socially isolated and shunned, to being placed under the microscope when the male doctors in my residency program were not, to being told that maybe I was smart and beautiful, but I was not doctor material. Maybe I should become a porn star instead."

Not every doctor who experienced a drop in self-esteem went through a traumatic experience in training. "As we age, self-confidence may dwindle," a pediatrician pointed out. "I find that I am looking things up more than I used to. Clinical knowledge has greatly grown, and the expectations of and demands from doctors have steeply risen. It's hard to keep abreast of the latest thinking on many topics. Many things that we took for granted for years as being common practice are now being questioned. All this can rattle one's confidence."

"In my case, med school and residency training had nothing to do with busting my morale," a psychiatrist wrote. "In those environments, I found a supportive culture and an investment in my personal success. For me, the destructive forces are corporate in nature: prior authorizations; robocalls from pharmacies; audit threats; malpractice liability threats; maintenance of certification board exams; the endless and seemingly impossible demands to keep up with HIPAA [Health Insurance Portability and Accountability Act] requirements even as my patients email me every day; frequent coding changes; and the nebulous standards of care offered by contradictory 'evidence-based' sources. This profession is intensely demoralizing and dehumanizing. The business context of clinical services creates lucrative roles for managers but burns many doctors to toast."

"I'm not trying to sound macho," an oncologist opined, "but I still feel that having tough med school/residency experience helps to weed out the wheat from chaff. Even if we make the programs more humanizing, some weak souls will drop out, as they are not cut out for this profession."

"It's unfortunate for those who enter medicine if they couldn't handle it," an emergency physician agreed. "It's sad that PTSD, depression, suicide, broken marriages, and drug/alcohol abuse occur from these unavoidable pressures. It's a shame if you feel that you wasted your 20s and early 30s buried under an avalanche of preparation and humiliation. But this is the course we set. It is the burden that we must bear. It is why becoming a physician is NOT a career."

"What a sad view of our profession," a family physician noted. "I guess I was lucky. At the medical center where I trained, the program was supportive and encouraging. I experienced some pretty awful surgical residents during surgery rotations, but this only lasted for a few months. I am sorry for the terrible experiences you have all endured. Your training should not have been like that."

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