Understanding the Sacrifices we Make in Medicine

I’m a third year psychiatry resident at Johns Hopkins and have an academic background in bioethics. I enjoy reading and writing about medical education, medical history, and virtue ethics.

For the past few months, I’ve been reflecting with colleagues on the sacrifices that are part of our job. I was reminded of these sacrifices last month, when I saw a patient—in a moment of anger—spurn our care and demand discharge after I’d invested hours of time every day for a few consecutive days. While the interaction wasn’t about me, I left that conversation feeling a stinging sadness. Patient care sometimes costs us emotionally, but that’s not the only sacrifice clinicians make.

The pandemic has increased and emphasized the sacrifices that health professionals make every day—risk of exposure to the virus, inadequate PPE, long hours, extra shifts, frequent redeployment, delayed learning experiences, separation from friends and family, lengthy quarantines, social stigma, and the immense psychological toll. But sacrifice has always been a part of clinical training and practice, even before the pandemic.

The Oxford English Dictionary describes sacrifice as “the surrender of something valued or desired for the sake of something having, or regarded as having, a higher or a more pressing claim.” Health professionals experience sacrifice from the beginning of their careers. While in school, they give thousands of hours to study, forego social opportunities, and spend many more years in training than most of their peers. Patient care is often stressful, emotionally taxing, physically exhausting, and sometimes thankless. Most clinicians have grappled with working late hours, spending little time with their families, documenting at home in evenings and weekends, responding to patient emails and calls at all hours, and complying with continuously changing regulations.

What is the “higher” claim—the purpose for which clinicians sacrifice? These sacrifices are most meaningful when understood as a part of a professional devotion to the good of the patient. To frame it in medical and bioethical language, these sacrifices are a “side effect” of the principle of beneficence. No one gives a medication for its side effects—clinicians acknowledge the side effects, but give medication for the therapeutic purpose. Similarly, to devote oneself to giving excellent care to every patient, health professionals must acknowledge the accompanying personal sacrifices.

Viewing these sacrifices as part of the project of the purpose of medicine—the health of patients—allows clinicians to understand, even accept, these sacrifices. When clinicians look to their profession for stability, relatively high salaries, or social esteem, these sacrifices feel like things to resent or dread that can lead to burnout.

How can clinicians have a healthy view of sacrifice in their professional growth? We’ve seen unhealthy views of sacrifice, such as the “no pain, no gain” mentality and the “you’re not a ‘real’ doctor unless you’ve . . . ” mindset. A healthier approach might be to start thinking about one’s own attitude toward sacrifice, which shifts to a reflection on character. In “Character Strengths and Virtues,” Seligman and Peterson describe several virtues and character strengths that are relevant here including persistence, kindness, and temperance—the latter of which they define as “a form of self-denial that is ultimately generous to the self or others.”

Take a minute to reflect:

1. What was a recent sacrifice I had to make in my role as a health professional?

2. How did I respond to it internally?

3. How did I interact with others about it?

4. Is this compatible with who I want to be as a person?

My own answers aren’t flattering. But as I pause to think about my impatience during a late night in the hospital with dinner waiting on the table at home, I find it calming to remind myself about the good my team was able to do for a few patients during those hours.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.