What Matters Most to You as a Doctor?

— Lessons from teaching a class on meaning in medicine

A photo of a female physician looking out a window.
Bair is a resident physician. Johnson is a medical oncologist.

It is a well-known phenomenon that burnout -- defined as emotional exhaustion, depersonalization, and apathy towards work -- is endemic among physicians. While studies have demonstrated that a loss of meaning in one's life and career increases susceptibility to burnout, it is still disheartening, though not entirely surprising, that many physicians say they find no meaning in their profession -- a profession once considered more mission-driven than most.

While the conversation on burnout largely revolves around systemic factors, from excessive administrative burdens and inadequate staffing to inconvenient electronic health record usage and the corporatization of healthcare, the question remains: is there anything within an individual clinician's control that can help restore meaning in their work?

Over the past year, as a fourth-year medical student at Stanford Medical School (Bair) and medical oncologist at Stanford Health Care (Johnson), we have examined this very question on a podcast called The Doctor's Art, on which we interview clinicians, educators, and researchers to explore what makes medicine meaningful for them and how they have overcome burnout. In spring 2023, we conceived and taught a medical school course titled Meaning in Medicine: Staying Connected to What Matters Most in order to share our most salient learnings with medical trainees.

Broadly, our course was designed to help students, particularly those in the early stages of training, identify and articulate their own ethical, cognitive, and humanistic impulses for choosing medicine as a career. We have found that most medical students, even those halfway through medical school, are largely unaware of the challenges they may face in this career path -- long hours during residency, the encroachment of professional responsibilities on personal life, the often-overwhelming pressure to climb the academic ladder, and more. The idea is that, by introducing students to these issues early on and giving them a space to reflect deeply on what really matters most to them, we might "immunize" them against burnout.

Each of our 10 weekly sessions over the academic quarter used one or two specific podcast episodes as a springboard for thematic discussions. Through an episode featuring psychiatrist Pooja Lakshmin, MD, students considered what wellness truly means to them; an episode featuring ICU physician Wes Ely, MD, taught students why spirituality has a role in medicine and how we can approach matters of faith tactfully with patients; an episode featuring grief expert David Kessler allowed students to envision how they might grapple with suffering as an inevitable part of clinical practice; through an episode featuring Robert Waldinger, MD, director of the Harvard Study of Development, we explored why personal, emotionally rich relationships are key to a fulfilling life. vv

Sessions were interspersed with mini-lectures on topics including managing conversations with patients facing serious illness, distinguishing values, goals, and preferences, and finding mentors who can cultivate our character and values in service of building a life -- not just a career -- filled with moral resonance. However, fundamentally, what we endeavored was to foster a space for open-ended dialogue so that students may develop a deeper understanding of themselves, of their life choices regardless of -- or perhaps in spite of -- the expectations others have for them, and of what it means to care for another person.

The reactions and feedback from our students have been eye-opening. Before and soon after the course began, we received interest from nearly a quarter of the institution's preclinical students; it was evident students yearned for an opportunity to talk about these issues, often overlooked in the traditional medical curriculum. In addition to medical students, we welcomed students in the physician assistant program as well as undergraduate pre-medical students. The diversity of personal experiences shared during class discussions underscored the importance of interdisciplinary learning, enabling students to see medicine in a broader social and human context.

To us, the most striking aspect of our class discussions was how frequently matters of faith emerged. While faith is seldom mentioned in medical education or discourse, we found students far more willing than anticipated to express their spiritual beliefs. In an anonymous pre-class poll, over half of the students indicated they had a religious affiliation and all students described spirituality as having at least a "somewhat important" place in their lives. It is therefore all the more vital that we provide a safe space for students to explore these beliefs and their influences on students' professional identities.

A paradoxically simple yet radical idea that surfaced was the significance of honoring the people and activities outside of medicine. In medical education, long hours of study, rigorous clerkship schedules, and a culture that relentlessly compels trainees to prioritize academic "enrichment," such as research, over everything else, combine to suggest that success in medicine necessitates hobbies to be relinquished and time spent with loved ones to be sacrificed. Gradually, trainees construct habits of mind and behavior that ensnare their identities inextricably with their profession. Students in our class relished in discussing their interests and the people who mattered to them; the realization that these aspects of life need nourishment too is crucial in achieving balance in a medical career.

Finally, despite how early our students were in their medical careers, they were able to share powerful stories of what drew them to medicine, whether it be caring for a family member with a chronic disease, working at a mobile clinic in an impoverished region of the world, or accompanying a patient at the end of life as a hospice volunteer. These narratives, filled with moments of vulnerability, resilience, despair, awe, and hope, are reminders of the core humanity underpinning the clinician-patient relationship, helping rekindle a passion for healing amid the overwhelming demands of the profession.

At the end of the course, every student reported they would recommend the course to their peers. In medicine, where science converges with art, suffering meets solace, and the human spirit confronts the limits of the body, it is increasingly easy to lose sight of our purpose and of ourselves. But our students have shown an eagerness to cherish their personal, intellectual, emotional, and spiritual motives for entering the profession; this eagerness, in turn, instills the courage and wisdom to seek balance and meaning. All medical trainees ought to be afforded the opportunity to do so, for this, ultimately, is just about the most effective way to individually prepare future clinicians against burnout.

You too can take a moment, step back, and ask yourself, what matters most?

Henry Bair, MD, MBA, is a resident physician at Wills Eye Hospital, who graduated in 2023 from the Stanford University School of Medicine. He is a member of MedPage Today's "The Lab." Tyler Johnson, MD, is a medical oncologist at Stanford Health Care.