Thirty years ago, I entered Loyola Medical School, and my initiation into the culture of medicine began. As best as I could at the time, I prepared myself for the challenges ahead. I aimed to cultivate a strong will, a powerful intellect, and what I hoped would be enough emotional maturity to succeed. I did not have any family connection to medicine, but I knew our society had certain expectations of me in my role as a medical professional. I did not know that during my training, I would have to develop a persona to hide my insecurity and sensitivity.
This persona was like a mask that enabled me to project a sense of confidence, knowledge, and strength to the people around me. It also allowed me to elevate myself and hide the deep sense of inner shame I carried within me. In this culture of medicine, which emphasizes head-based energies and focuses on competition, rationality, and science, my intellect would become master, and my heart-based energies of empathy, compassion, connection, and acceptance had to be adapted and concealed. To conform to the norms of medical training, I felt compelled to suppress my heart-based energies and focus my attention on developing my mind.
This learning was driven home forcefully one day during my third-year rotation in general surgery. I was taking care of a man in his fifties with pancreatic cancer who needed extensive abdominal surgery. I was the first to see him every morning, and sometimes our conversation turned to his family. He had a wife and two teenage daughters and was concerned about the effect of his illness on them. One morning, on rounds with the surgical team, I expressed genuine sadness and grief that I was holding for this patient and his family. The senior resident stopped rounds and humiliated me before everyone, stating clearly, “We are technicians. We do not allow feelings and emotions to compromise our solid judgment. Your feelings do not belong here. What will make you a good physician is your strong intellect, confidence, power, sacrifice, and hard work.”
I struggled with what that resident said and did to me. I questioned the validity of his words. That experience left an emotional scar of shame and isolation that I still tend to 27 years later. I desperately wanted to be a physician and conform to the customs and values of the successful physicians I aspired to be like. It was difficult for me to abandon my heart-based energies of emotions and feelings, so I developed adaptive behavior patterns to succeed. I tightened the mask, put on another layer of armor around my heart, and settled uncomfortably into my persona of competence and self-assurance.
Reflecting on my life, I had been practicing similar adaptive behaviors from an early age of four or five years old. In my childhood environment of fear and uncertainty, strong emotions were not allowed, and vulnerability was shunned. In the chaotic environment of not belonging, I developed a strong, independent spirit and took responsibility for myself and others around me. External achievement and competition were rewarded and encouraged. These behavior patterns enabled me to conform to my family system and proved useful in conforming to the rigors of the medical system.
Unfortunately, three of my friends seemingly couldn’t navigate the complexities of the medical culture and chose to end their lives. One of them was my chief resident. His death was especially difficult for me because I saw him as a mentor and the type of physician that I aspired to be. He had a strong mind and elevated status. I imagined that he had all the answers, but he still took his own life. Now, where would I look for answers, for a role model to follow?
In time, it became difficult for me to differentiate what was me and what was my persona. A deep inner tension began to develop, and I realized I was putting my relationships and possibly even more at risk. These adaptive patterns interfered with my personal and professional relationships and made it difficult to fully connect with my wife, three kids, patients, coworkers, and even myself. People I was in relationships with did not want me to show up with a mask and a persona that protected me from intimacy, connection, acceptance, and love.
In 2013, I reached an especially challenging point. I was so focused on my mind and solving problems that I almost had to break my heart to know I had one. I remember a chilling moment one night when I was sitting alone in my three-season room, catching up on Epic documentation. For months, I suffered in my attempt to solve my relational problems with my mind—my thoughts, my reason. That night, my attention turned to my three friends who took their lives. Were they trying to solve deep relational problems with their minds, just as I was doing? I could not come up with an answer, and that scared me.
With the help of my wife, I reached out for help, and I started working with a physician coach. He helped me understand my adaptive patterns of behavior and normalized them in the context of the culture of medicine. I was not alone, and I did not have an irreparable flaw. He helped me reconnect with my natural feelings of compassion and empathy, especially toward myself. This relationship sparked a decade-long journey of self-discovery, revealing the many layers of my personality and deepening my awareness of the fundamental components of building and maintaining meaningful relationships.
I now know the truth: being a good doctor means being intellectually, relationally, and emotionally skilled. I hope that my son and his colleagues, who are starting their first year at the Medical College of Wisconsin, can help reshape the culture of medicine by learning early in their careers how to integrate their heads with their hearts.
Brett Linzer is an internal medicine-pediatrics physician.
