John P Kolcun, MD

Necessary Discomfort

“Who is the happy Warrior? Who is he

That every man in arms should wish to be?”

 

– William Wordsworth, “Character of the Happy Warrior”

At the risk of losing your attention before I’ve gained it, dear reader, grant me two favors before we begin:

First, pause and recall a time you felt supreme pride. A moment of achievement, satisfaction, victory. Consider the same of your friends, family, even celebrities or historical figures you admire. Keep these in mind.

Second, stop reading this essay (temporarily!) and go read “Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training” by Dr. Lisa Rosenbaum, an assistant professor at Harvard Medical School and practicing cardiologist at the Brigham.

To what end? Please consider:

By a thousand small steps, we have reached a cusp in modern medicine: what does it mean to be, or rather to become, a physician?

For surgeons, the monastic, all-consuming, and frankly brutal training structure of the past has been abandoned (as I explored here, for a shameless plug). And indeed, recent decades have seen rapid and unprecedented changes to both medical school and residency writ large: work-hour restrictions, pass/fail grading systems, optional attendance for lectures, “wellness” days off, etc. (ad nauseum).

There were problems with medical training 100, even 50 years ago: stipulated. But overcorrection – however well-intentioned – could result in a system that doesn’t actually train people, doesn’t make physicians. Instead, we may produce credentialed graduates who have gained knowledge, without skills. Medical school is, after all, vocational. And part of learning how to do something is becoming the type of person who does it: we think differently, we react differently, we tolerate differently. Perhaps a shift away from transformative vocational training in medical school partially explains why a whopping 61% of surveyed US medical students recently said they don’t plan to treat patients in their careers! Clearly, these students aren’t becoming physicians, even if they’re “learning medicine.”

Becoming something stronger, smarter, better, is by its nature uncomfortable. My mentor and friend Dr. Mike Wang often says “you can’t just slap a patch on your shoulder and call yourself an astronaut.” And there are countless cliched examples: boot camp, butterfly cocoons, diamonds under pressure – we all know the metaphors, because they’re all simply true: transformation isn’t free. And for the concerned citizens in the back of the room, working hard and even being tired (gasp!) is safe, for trainees and patients alike; as anyone who’s worked in a hospital knows firsthand.

The cost of transformation is likewise the price of pride. Remember your moment of victory: was it something easy, or something hard? We don’t tell epic tales about walking through the park on a sunny day. We remember, admire, and award the mountains climbed, records broken, dragons slain.

Medical training, becoming a physician, is not and should not be easy: the consequences of failure are too high. Therefore I beg you, dear reader: be the Happy Warrior! Face the worst days with a smile, and remember that transformation is, necessarily, uncomfortable.