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Dr Bernard was a National Health Care Scholar and served at a Federally Qualified Health Center in Immokalee, Florida for six years after her residency. She then worked for a large out-patient hospital group before opening her own practice, which she con
You're not the only one who's feeling a bit stressed.
Every year, it’s the same old joke. “Whatever you do, don’t get sick in July!” And just like clockwork, the new intern memes are making the rounds on social media.This year, they have a COVID19 spin: “Wear your mask, or you’ll end up getting intubated by an obstetrics intern who did their last semester of class on Zoom!”
I’ll admit, I used to think these jokes were just a bit of light-hearted fun. I recall repeating the July 1 mantra in a self-deprecating way as a former intern. After all, I didn’t really believe that I was a serious danger to my patients—a senior resident was always by my side and an attending physician was just a phone call away. If anything, like most of my fellow interns I was a bit overcautious, poring over patient charts and worrying over the safety of simple orders like Tylenol or sleep aids for my hospitalized patients.
But I think about these jokes differently now. Maybe it’s because I’ve learned that up to up to 75% of medical residents develop burnout during their training period, with nearly 30% developing clinical symptoms of depression. The risk of suicide also increases in residency, with most suicides occurring in the first and second years of training. Of these suicides, over a third occur during the months of July through September—one of the most stressful transition periods in the life of a new physician.
As I reflect on my own use of dark humor during these years of training, I realize it was likely a subconscious defense mechanism to help me cope with my own anxiety and fear about harming patients. And while a sense of humor can be an important mechanism to deal with stress, “gallows” humor in medicine can easily become maladaptive, leading to cynicism, one of the cardinal symptoms of physician burnout.
Unfortunately, learning how to accept and cope with our feelings in a healthy way is not something that comes easily. While medical schools and residencies now incorporate psychology training and self-care into their curriculum, it takes time and practice to develop healthy coping mechanisms. Experienced physicians can help our newer colleagues by modeling healthy behaviors and avoiding coping shortcuts like black humor or compartmentalization of feelings (“suck it up!”). Even better, we can provide mentorship and encouragement of our junior colleagues. I was touched by a Twitter thread I recently saw in which physicians recalled times that their senior residents or attendings had complimented them. Doctors reported that a simple “great job” or high-five from a senior had galvanized them through tough times and was one of their most powerful memories from training.
Another reason that I have come to dislike jokes demeaning interns is that I have come to see them as a part of a greater systemic effort to devalue physician training. By the time physician graduates from medical school, they have already received over 6,000 clinical hours of hands-on experience, far less than the 500 hours required for graduating nurse practitioners or the 2,000 hours required of physician assistants. It’s easy to tease a new intern for not yet knowing their way around the hospital floor or understanding the finer points of facility protocols, without considering the years that these new physicians have already dedicated to acquiring the fund of knowledge they will need to correctly diagnose and treat patients.
Interns aren’t the only ones who are targeted by jokes devaluing the role of the physician. Social media memes teasing doctors abound, with sayings like: “Be nice to nurses. They keep doctors from killing you.” Or “Do you want to speak to the doctor in charge? Or the nurse who actually knows what’s going on?” Recently when shopping at one of my favorite discount stores, I literally gasped when I stumbled upon a wall plaque that said, “Nurse: Kind of like a doctor but nicer.” My 13-year old niece who was shopping with me laughed. “You’re nice most of the time,” she told me, reassuringly.
While I agree that many nurses are angels on earth (my own mother being one of them), must we extol their virtues at the expense of physicians? While doctors who complain about these jokes may be accused of being oversensitive, with society’s every-growing distrust in scientific expertise, these anti-doctor jokes may chip away at the already fragile trust that patients place in their physicians.
Moreover, criticisms of physicians masked as humor may lead patients to accept or even seek out care by non-physicians, who have less education and training. Patients and politicians alike have been swayed by the mantra: “Nurse practitioner: Heart of a nurse, brain of a physician,” with 23 states and the Veterans Administration allowing nurse practitioners to treat patients independently. And nurse practitioners aren’t the only ones seeking to take on the role traditionally played by the physician. In 2019, North Dakota became the first state in the Union to allow physician assistants to practice without physician supervision. And as thousands of physicians were being furloughed, nurse practitioner and physician assistant organizations have used the COVID19 pandemic as justification to request further expansion of practice rights across the country.
There are no shortcuts to becoming a physician, and those who choose to follow the long and rigorous path of medical education should be lauded rather than mocked. We chose this path for a specific reason—because we wanted to provide the absolute best care for our patients. So, the next time you hear a “joke” about patients being at risk from physician-led care, take a moment to gently set the record straight: Doctors have not only the education and training to care for patients, but we have hearts, too.
Rebekah Bernard is a family physician and the author of Physician Wellness: The Rock Star Doctor’s Guide.Change Your Thinking, Improve Your Life. She can be reached at her self-titled site, Rebekah Bernard, MD.