Unlearning Medicine’s Culture of Self-Sacrifice

It’s Friday at 4 PM when the chills begin. I’m at a hotel a few hours from home for a weekend board meeting, with a reception in two hours and an all-day meeting on Saturday. I pop two Advil, pull the duvet off the other queen bed, and bury myself in blankets while I wait for my teeth to stop chattering.

The thought of going home doesn’t occur to me. Instead, my most pressing concern is where I can find a face mask to avoid spreading my virus to others.

It’s a familiar story. So familiar, in fact, that it has a name: presenteeism.

Where does this urge come from—the drive to push through illness, injury, or mental health crisis? To show up for work and other responsibilities when we really should stay home? To give more and more of ourselves until we simply can’t anymore?

Is it our Type A personalities? Fear of letting others down? Fear of missing out? An inflated sense of our own importance? Or does it come from a culture of medicine that taught us “professionalism” meant putting everyone else’s needs above our own, and that revealing human frailty was a sign of weakness?

For me, it’s all of the above. But more than my own relatively minor illness has brought this question to the forefront of my mind.

Recently, I attended the third annual FlexMed Summit, a program that teaches physicians how to move beyond the burdens of traditional employment through direct contracting. With many locum tenens physicians in the audience, one session focused on safety while traveling and working in remote locations.

Emergency physician Tracy Sanson, MD, urged doctors to prioritize their health and safety, including protecting themselves from violence in healthcare settings. Her message was to “stand up for yourself, because nobody else will.” Then she said something that struck me to my core: “If something happens to you, your job notice will be posted before your obituary is.”

That message resonated even more yesterday, when I received an email announcing that a longtime physician leader had died suddenly.

I didn’t know him well, but we had met at several meetings. He had moderated panels I participated in and offered kind words about my work on scope of practice. I had heard him speak up for physicians and patients, and I knew he had volunteered countless hours to the organization.

Now he’s gone. My social media feed filled with condolences and tributes to his life and work. But in time, the messages will fade, and life will go on.

The same will happen for all of us.

My hope—for him, for me, and for all of us—is that we are living with intention. That the responsibilities we take on reflect our goals and values. That we make the most of the days we have, while giving ourselves grace on the days we simply can’t do everything we planned.

That doesn’t mean every sacrifice is a mistake. It means asking whether we are making a deliberate choice or responding to years of conditioning that tells us we must always push through.

One of the gifts of direct care is the flexibility to make those choices.

We can shape how we practice: when to reschedule patients because we’re sick, what access to offer outside business hours, and how to arrange coverage so we can take a vacation. We have the freedom to build a practice that makes room for our own health and lives.

But having that freedom and allowing ourselves to use it are two different things.

Choosing to care for ourselves can feel uncomfortable, even when it is the right decision for our patients.

When we work through a contagious illness, we risk exposing them to whatever microbe we’re brewing. I shudder to think of the hospitalized patients I may have exposed when I was a medical student and resident. We also risk giving patients less than our best. Who can think clearly or listen attentively while feeling miserable?

When we pressure ourselves to offer “unlimited” care or remain constantly available, we risk reaching our physical and psychological limits—and compromising the care we set out to provide.

The same applies to how we run our practices. Setting fees too low to sustain the business, doing everything ourselves when we need help, or repeatedly accommodating unrealistic patient expectations can undermine both our well-being and our ability to keep caring for patients.

An affordable practice still has to be a sustainable one.

As I write this, I’m talking to myself, too.

Despite all my big talk, I did tough out that Saturday board meeting, coughing into my surgical mask. As late as Monday morning at 8 AM, I was still negotiating with myself about whether to go in and see patients. Finally, I agreed to have my office manager reschedule them.

Even now, as I type these words, I’m wrestling with guilt and the fear of letting people down. I’m searching for the magic thought that will undo years of messaging about self-sacrifice—and my own intrinsic drive to ‘do it all.’

I haven’t found it yet.

For now, acknowledging the struggle will have to be enough.