Toxic Professionalism in Medicine: The Culture Must Change

The medical profession carries a strong reputation for prestige, ideally rooted in principles of compassion, integrity, and altruism. However, a culture of toxic professionalism has persisted, adversely impacting physicians, medical trainees, and the quality of patient care. This toxic culture can manifest in several ways, including privacy invasions, hierarchical structures, excessive workloads, and unrealistic expectations of perfection. It can also result in burnout and compromised well-being for healthcare workers. Addressing and changing this culture is crucial to ensuring a healthier medical profession and better patient outcomes.

Physicians Are Not Public Figures

Physicians occupy a unique position in society, as they are entrusted with the health and wellbeing of their patients, and are privy to people’s most vulnerable moments. However, it is important to recognize that physicians are not public figures in the same sense as celebrities or politicians. They should not be subjected to the same level of scrutiny or unrealistic expectations from the public. This sentiment is widely held; a 2024 policy consultation by the College of Physicians and Surgeons of Ontario presented a draft of a new professionalism policy by the licensing body, which would police professionalism of physicians outside the workplace. The comments were overwhelmingly negative, with physicians outraged at the notion that they must be professional when not actively practicing their profession, and outraged at the possibility of constant scrutiny and perhaps surveillance of their personal lives.

Physicians deserve respect and privacy, both in their personal and professional lives, including social media. They have the privilege of supporting the public, but they are not public figures and therefore are entitled to privacy. Medical institutions must advocate for the protection of physicians’ rights and work to combat these unreasonable expectations and external pressures, which can adversely affect physicians’ mental health and well-being.

Hierarchical Structures and Power Dynamics

One of the most problematic aspects of toxic professionalism in medicine is the rigid hierarchical structure that often exists within healthcare settings. This hierarchy can stifle open communication, inhibit collaboration, and create power imbalances among healthcare workers. Junior physicians, residents, and medical students may find it difficult to voice their opinions, concerns, or adverse experiences for fear of repercussions, which can hinder their learning and professional development.

Moreover, this hierarchical culture can also perpetuate a lack of diversity and inclusion within the field, as individuals from marginalized groups may face barriers to advancement or encounter discrimination. Addressing these power dynamics and promoting a more equitable and inclusive work environment is essential to cultivating a healthier culture in medicine.

Excessive Workloads and Burnout

Another manifestation of toxic professionalism in medicine is the excessive workload that many physicians and medical trainees face, with a general expectation that a professional physician tolerates it quietly. When younger physicians advocate for more humane workloads, older generations of physicians often make disparaging comments about how easy we already have it, silencing advocacy. The demands of the profession, coupled with administrative burdens and long working hours, can lead to burnout, exhaustion, and a decline in job satisfaction. There have been concerted efforts to limit the length of on-call shifts, but they are still dangerously long, often over 24 hours of work without sleep. Burnout not only affects the well-being of physicians but also impacts the quality of care they provide to patients.

To combat this issue, medical institutions must prioritize physician wellness and work-life balance. This may include addressing inappropriate attitudes toward progress, implementing policies that reduce administrative tasks, reducing working hours and providing flexible scheduling, and offering non-stigmatizing mental health support that does not lead to repercussions for one’s career such as enhanced scrutiny or closer monitoring. By addressing the root causes of burnout, medical institutions can create a healthier work environment for physicians and improve patient care.

Unrealistic Expectations of Perfection

Toxic professionalism in medicine often involves unrealistic expectations of perfection, which can place immense pressure on physicians and other healthcare workers. The culture of medicine may discourage vulnerability and self-compassion, leading to a fear of failure and a reluctance to seek help when needed. Fellow physicians may withhold compassion and look down on struggling colleagues as less capable by nature, instead of acknowledging the impact of a problematic environment. This can result in a lack of openness about mistakes or challenges, which can hinder learning and growth.

Physicians often feel ashamed of needing to take time off work for burnout or mental illness, and for good reason: physicians, even psychiatrists, commonly show implicit or explicit biases against those with mental illnesses. If a student shares a peanut allergy, the teacher would avoid providing the student with peanut-laden snacks. Yet if a medical trainee expresses distress with some aspect of the system to the extent of suicidal ideation, the system labels this as unprofessional and threatens professionalism remediation, because there is an expectation that trainees should never speak to their superiors about suicide. In a world where even psychiatrists are biased against mental illness, is it any wonder that physicians are unwilling to disclose and seek treatment for their illness, and instead face high suicide rates?

Medical institutions must foster a culture that encourages open communication about mistakes and challenges, and a culture where physicians show much more compassion to their colleagues than they do at present. By promoting a more supportive environment, physicians can feel empowered to learn from their experiences, strive for excellence, and seek help for burnout or mental illness, without the burden of perfectionism.

Promoting a Culture of Change

By addressing these aspects of toxic professionalism in medicine, medical institutions can create a healthier culture that supports the well-being of healthcare workers and therefore enhances the quality of patient care. The culture of medicine must evolve to prioritize boundaries between one’s professional life and one’s personal life, dismantle the egos that lead to hierarchy-induced problems, reduce workloads and cap work hours, and address negative attitudes toward progress, starting by dropping the unreasonable expectations of perfection.