“What are you doing there?” Utter disbelief rang in the voice of my attending, as if I were spraying communist slogans on his house.
I was actually trying to shove in the second fork of a limp salad from the cafeteria while standing. “Surgeons don’t need to eat!” I was waiting for a hint of a smile, a smirk, anything indicating that he was joking. But nothing, just cold grey eyes. The second time I was “caught” was in a different hospital, exiting the elevator heading for lunch when I was tapped on my shoulder and stopped by my chief attending: “If you have time to eat we obviously have too much staff in our department,” she said.
For years I was peeking nervously over my shoulder when having lunch, if I dared to have it at all.
Back then I was a fifth-year surgery resident, a father, and a grown man. And I was afraid to have lunch. Clearly there is something wrong.
This absurd reality reflects a deeper problem in our profession - a fundamental misunderstanding of what it means to be a physician. The solution lies in distinguishing between two fundamentally different approaches: the Old School physician mindset that glorifies suffering, and what I call the New School physician mindset that prioritizes our wellbeing as the foundation for excellent patient care.
To the basics: ASICS - anima sana in corpore sano - a healthy soul in a healthy body - this is an eternal truth that we preach our own patients day in day out. But we are not able to apply it to our own lives. On the contrary.
Becoming and being a doctor is no walk in the park. Everyone knows that, and I knew that, and after all, it was my free choice. The long hours, the responsibility, the administrative and legal burdens, the at times abominable working conditions and environments have been pointed out time and again. The stress can be enormous.
The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (Macaron M.M. et al., Frontiers in Psychiatry, 2023; https://doi.org/10.3389/fpsyt.2022.1071397).
The statistics tell a sobering story. Burnout among physicians remains high worldwide. A comprehensive COVID-era meta-analysis found an overall prevalence of ≈55%, with significantly higher odds among frontline clinicians and regional variation (https://doi.org/10.3389/fpsyt.2022.1071397).
In emergency medicine, pooled international prevalence reached ≈43% (95% CI 32–54%), underscoring that high stress is a global, not regional, phenomenon (https://doi.org/10.3390/healthcare11152220).
In the United States, the most recent Mayo Clinic Proceedings data show physician burnout falling from 62.8% in 2021 to 45.2% in 2023, returning to pre-pandemic levels yet remaining alarmingly high (https://doi.org/10.1016/j.mayocp.2024.11.031).
We are one of the professional groups with the highest rates of illicit substance and drug abuse, suicide rates and premature deaths. And this is no longer only affecting physicians themselves - physician burnout directly correlates with increased patient safety incidents, decreased professionalism, reduced patient satisfaction, and higher turnover intentions, as demonstrated in comprehensive BMJ meta-analyses (https://doi.org/10.1136/bmj-2022-070442).
A particularly insidious contributor to modern physician burnout is electronic health record (EHR) fatigue. We spend more time documenting care than providing it - studies show physicians spend 2 hours on EHR tasks for every hour of patient contact. This administrative burden represents a form of moral injury, forcing us to prioritize documentation over healing. The ICD-11 now formally recognizes burnout as an occupational phenomenon resulting from chronic workplace stress, acknowledging that systemic factors like EHR burden require organizational-level solutions alongside individual interventions (https://doi.org/10.2147/JHL.S389245).
But one of the root problems lies somewhere else. It is a force that at times opposes change for good from within.
It is our common mindset. The mindset that defines how we think we as physicians have to act and interact within this system.
This is what I call the Old School physician mindset.
The practice of medicine is often associated with that of a selfless practice. A term that has been badly misunderstood. Selfless in the sense of no ego, no personal agenda driving the practice, yes. But it never was intended to deprive us from our natural physical, emotional, spiritual and social needs, that we - human beings after all - have, too.
I oppose the implicit and explicit suggestion of physician martyrdom as the only way of practicing medicine.
Neither the Hippocratic oath, nor Lasagna’s modern interpretation of it or Inman’s “First do no harm” indicate at any point that our profession should go at the expense of our own wellbeing.
Yet the Old School mindset has often created a toxic culture where suffering becomes a badge of honor. As a collective, we take some sort of sick pride in suffering, comparing who works and harms himself more. It leads to a twisted form of false, perceived heroism, where a delusional mind fights its very own body.
I lost one great grandfather physician to morphine and one grandfather physician to myocardial infarction. I have seen colleagues smashing trash cans, kicking holes in walls when the pressure got too high and their underdeveloped coping strategies failed. I saw them literally smoke themselves to death, or get admitted to their own ICU in a diabetic coma.
I have seen way too many near accidents such as wrong surgery site markings, faulty prescriptions and other concentration deficit derived mix-ups. And I have seen a patient die because of a catastrophic cascade of decisions made by physicians trapped in ego-ridden decision making. This should not be.
The prospect of working the rest of my life in such self-wrecking conditions made me quit medicine for good twice.
Only one mentor’s reminder to “focus on changing what is within your reach. Change from within” kept me coming back.
This mentor’s wisdom points toward a different path - one that acknowledges the reality of systemic problems while empowering us to take control of what we can change. The problem is not that these things happen, but that we shrug them off as something inevitable, as the status quo. This is what I call the old school physician’s mindset which puts a skewed idol image of our profession first.
In contrast, a New School Physician mindset puts ourselves as doctors first.
Not the profession. Not the patient, but ourselves.
Safety first. We know that from first aid guidelines and airplanes - make sure you don’t endanger yourself, it helps no one.
We can’t give if we have nothing to give, if we get consumed in the process.
We must stop postponing it to some indistinct point in the hazy future.
To be clear, this is not about creating a medical la-la land for physicians. And it is definitely not about jeopardizing patient care because of petty personal issues.
The New School approach is actually about becoming better physicians through conscious self-care. It is about acknowledging one’s personal needs. It is about building up the strength and courage to express those needs, even against implicit or explicit threats from our peers or more importantly against imagined threats of our minds.
It is about taking responsibility for your own life. It is about actively deciding how to spend our time; how to do what we do. It is about making conscious choices for ourselves.
The moment we become true and honest about ourselves to ourselves, we become better doctors as well.
So what does this look like in practice? How would this look like? Take one step back and take a bird’s-eye view on your current life.
And then examine your life’s situation as you would with your own patients.
What are the most pressing issues?
What would you recommend to a patient under those kinds of circumstances?
I believe there are many things we can do in the realm of mindset, organization, lifestyle and communication to help us feel better again.
And most likely, every single one of us already knows exactly what that would be in our case.
When we embrace this New School approach, the benefits extend far beyond our personal wellbeing. If we know our truth and can stand up for it, we become independent from other people’s conflicts of interest. We then can start treating our patients to our best knowledge.
And we can be truthful and honest with our patients as well, without having to be afraid to disappoint them or make them feel bad.
And most importantly without risking harming them by harming ourselves.
This would also reduce pressure and stress, and foster wellbeing far more significantly than any external health reform ever could.
It doesn’t and shouldn’t take away the responsibility to improve structural and institutional conditions - but it is an important pillar to tackle this multifaceted challenge.
This is the future of medicine I envision - one where healthy physicians provide the best possible care because they’ve learned to care for themselves first. This is what a New School Physician would look like.
The choice is ours. We can continue perpetuating a culture that glorifies suffering and ultimately harms both physicians and patients, or we can choose to become New School Physicians - one conscious decision at a time. The transformation of medicine begins with transforming ourselves.
I wrote this piece in 2016. Back then I was too afraid to publish it.
I have slightly adjusted the text and updated some references - which haven’t fundamentally changed, what is telling in itself.
Since then I have moved through the ranks to be now in a position where I see this problem perpetuating itself also on the administrative side. And realizing that I have become part of the problem myself - and to a certain extent - hopefully part of more structural solutions as well.
The challenge requires both individual and systemic approaches. While evidence shows that interventions targeting medical residents yield only modest benefits when implemented in isolation, combined approaches show greater promise (https://doi.org/10.1186/s12909-024-06195-3). This reinforces the need for what I call the CARE framework - a practical approach for New School Physicians:
The CARE Principles
Consciousness: Developing awareness of your own needs, limits, and warning signs. This means regularly checking in with yourself: Am I hungry? Tired? Overwhelmed? Start with simple daily check-ins.
Advocacy: Building the courage to express your needs and set boundaries. This includes saying no to excessive overtime, requesting adequate break times, and speaking up about unsafe working conditions. Practice starts with small assertions.
Responsibility: Taking ownership of your wellbeing through concrete actions - overhauling diet, exercise and sleeping habits one at a time, getting up earlier to experience the feeling of “having time” again, and seeking professional help when needed.
Expression: Opening up about your challenges to colleagues and superiors, and fostering honest collegial check-ins. Taking microbreaks in the OR and using scrubbing-in times for genuine connection. Creating psychological safety in our teams.
While I don’t think that magic AI tools will make all our problems - or jobs for that matter - suddenly disappear, I see the potential to ease some of our burdens.
A lot of creative thinking, openness and persistence is required to move the needle on many other areas.
Let’s reflect and create change in the way we interact with ourselves, our colleagues as well as our system - one day at a time.
To more in life,
Nicco
If you need oxygen, this track might be what you need today: