When Medicine Stops Feeling Like Medicine | Ep39

Michael Hersh, MD

[00:00:00] 

There's a sentence that comes up a lot. When I talk to physicians. Usually it's an offhand comment, almost an aside, and it's something like this: I just feel stuck. They're not angry. They're not being dramatic. They're just worn down. And when you listen closely, it's almost never about a single bad day or one bad interaction or even one bad job.

It's about what it feels like to practice medicine right now. Like medicine is happening to you, and you don't have any moves left. Most physicians don't call that a victim mentality, and to be honest, I usually wouldn't either. But the way that feeling shows up over time matters more than it looks because long before you quit, long before you burn out, long before you stop caring, you've already started giving something away.

Well, hey everyone, and welcome back to the Better Physician Life [00:01:00] Podcast. Thank you so much for being here today. And before we go any further, I wanna be very clear. We're not imagining it. Medicine is harder than it used to be. It's more constrained, it's more managed, it's way more closely monitored.

Most of us are practicing inside systems we didn't design with rules that keep changing and expectations that don't always make sense. So if you feel frustrated or cynical or just tired of constantly pushing uphill, you are not alone. That's a completely understandable response to the environment we are all working in.

What I wanna talk about today isn't denying any of that. It's something subtler that can happen because of it. Over time, without meaning to [00:02:00] the job starts to feel different. Not always all at once, and not necessarily in a dramatic way, just enough that work starts to feel like something that's happening to us.

That's what I wanna look at today. Not to blame anyone, not to fix the system, just to notice where we may be giving up more control than we realize. What that costs us over time. And again, I wanna be clear about who I'm talking about. I am not talking about physicians who are already checked out, bitter, or looking for an excuse.

I'm talking about good doctors, people who still care about their patients, people who still show up, who still do the work, even when it feels harder than it needs to be. What I've noticed is that when the pressure stays on long enough, something shifts. Again in small [00:03:00] ways in how we talk about work before the shift even starts, and how quickly we assume the worst when something predictable happens, and how much of our mental energy is spent bracing instead of working.

None of that means you're doing anything wrong. It's how you get through the day. But over time, that way of operating can become the default. You start showing up as if medicine is something you have to manage your reaction to, and that's where the idea of victim mentality fits in. Just a name for what happens when medicine starts feeling like something that's happening to you rather than something you are actively practicing.

And you can usually hear it before the day even starts. Someone mentions the schedule, staffing, or a new policy that showed up in the inbox overnight, and there's an immediate reaction. A comment about [00:04:00] how this place works. A reminder that nothing ever really changes, a sense that whatever's coming next is already gonna be a problem.

It's so familiar. And I have done it too. Sometimes it shows up when something predictable goes wrong. The EMR slows down or shuts off altogether. A patient arrives late, a consult turns into more work than it should have been. And before anything has really happened, you are already reacting. Not because this one thing is unbearable, but because it feels like confirmation.

Confirmation of a story you've been telling yourself about how medicine works now. Sometimes it's more subtle than all of this. You still do the work. You're still professional, you still take good care of patients, but you stop offering suggestions. You stop pushing back. You stop imagining [00:05:00] alternatives.

You tell yourself you're just being realistic. You've seen this movie before. You know how it ends. And maybe you have, but there's a difference between being realistic and being resigned. Realism is seeing the constraints clearly and staying engaged. Resignation is deciding ahead of time that nothing you do will matter.

Realism says this is limited, so I'll need to think through this. Resignation says this is limited, so why bother? And the tricky part is that resignation often sounds like realism. It sounds like experience. Like you've been around long enough to know how this goes, but underneath it, something important has shifted.

You're no longer responding to what's actually in front of you. You are responding to what you expect will [00:06:00] happen. That's when medicine starts to feel smaller. Not because the system got worse overnight, but because you stepped back from it. And what often gets missed is what that costs.

When you assume the outcome in advance, you conserve energy, but you also give something up. You give up curiosity, you give up your influence. You give up the sense that your presence actually matters beyond getting through the day. Over time, medicine starts to feel less like a practice and more like a series of things you're reacting to.

That's not burnout. Not yet, at least. It's earlier than that. It's the moment when work stops feeling like something you're actively engaged in and starts feeling like something you're managing your reaction to. And this is typically when anger enters the picture. Because when you care about the work, and [00:07:00] most of us still do, frustration is unavoidable, and anger makes sense.

It's information. It tells you something isn't right. That something important is being compromised. The problem isn't the anger. The problem is what happens when that anger doesn't move you to action. Because there's a difference between anger that leads somewhere and anger that just spins.

Justified anger has direction. It shows up, it gets your attention, and eventually it pushes you toward a decision, even if it's a small one. You speak up, you draw a line, you make an adjustment, or you decide clearly that you're not gonna take it on anymore. Habitual grievance is different. It's anger that never turns into a decision, so it just becomes [00:08:00] this running commentary instead.

Same complaints, same conversations, same sense that this is just how it is. It keeps you feeling engaged, but it never actually moves anything. It becomes part of the background noise at work. You hear it in the way we talk about leadership. About policies, about how things always go around here.

And again, sometimes the complaints are valid. But grievance isn't about accuracy. It's about where your attention goes. When grievance takes over, everything is focused outward. Every problem reinforces the same conclusion. This isn't mine to change. That stance feels protective. It keeps our expectations low, and it helps us avoid disappointment, but it also keeps us stuck in reaction [00:09:00] mode.

You stay mentally busy replaying the conversations, running through internal arguments, building a case you never actually present. And from the outside, this could still look like engagement. From the inside, it's exhausting because grievance doesn't lead to decisions; it leads to vigilance. You are always scanning for the next problem, always waiting for the next thing to confirm what you already believe.

Even on good days, you never actually stand down, and that's the cost most physicians don't account for. Not the anger itself, but the constant bracing that comes with it. At some point, without meaning to, grievance starts doing the job of thinking for you. You already know how this is gonna go. You already know who won't listen.

You already know what's not worth trying, and that's when medicine really starts to feel like something that's [00:10:00] happening to you, not because the system suddenly got worse, but because you've been pushing against it for so long that it's become the way you work. This is where victim mentality actually takes hold.

It shows up as these subtle decisions we make over time, we make them over and over again. We just assume that we have less influence than we actually do, and the longer that assumption goes unchallenged, the more power it drains. And this is where a lot of us misunderstand what's happening.

Because what looks like disengagement from the outside often feels like protection on the inside, like putting on armor. You didn't put it on because you stopped caring. You put it on because you cared, and the hits kept coming. Armor makes sense. It keeps the frustration from spilling over. It helps you get through the day.

It lets you stay [00:11:00] functional in an environment that doesn't always feel reasonable. The problem isn't that armor exists. The problem is when it never comes off because armor doesn't just block the bad. It blocks options. When you're armored, reflection feels like accusation. Any suggestion sounds like pressure, and anything labeled as help feels like someone telling you that you are not seeing reality clearly.

So you tighten your circle. You limit expectations. You stop offering ideas unless you're asked. You stop imagining that your input will change much anyway. That's adaptation. But over time, that adaptation turns into a way of practicing and getting through your days. Still responsible, still getting the work done, but the part of medicine that felt like judgment, [00:12:00] discretion, leadership, that part starts to thin out, not because it was taken away from you outright, but because you stopped using it.

And that's the shift most physicians miss. Victim mentality doesn't show up as giving up. It shows up as narrowing. Fewer conversations you're willing to have. Fewer risks you're willing to take. Even small ones. Fewer moments where you step forward instead of managing around. What replaces it is efficiency, predictability, emotional distance, and those things all work until they don't.

Because eventually medicine starts to feel flat and we start to feel stuck. Technically fine, professionally acceptable, but without the parts that made it feel like practicing medicine. This is where accepting reality matters. Medicine in 2026 is [00:13:00] constrained. Corporate. Metric-driven. That part isn't going away, unfortunately.

The mistake is thinking that accepting the reality means surrendering authorship because there's a difference between acknowledging limits and living as if you're powerless inside them. Agency doesn't come back online through a big decision. It comes back in smaller moments. When you notice how quickly you assume the answer is no.

When you catch yourself bracing before anything has actually happened. When you realize you've been conserving energy by shrinking your involvement, not because you want to, but because it feels safer, because it feels easier, those moments matter. Not because they require action, but because they tell you where you've been setting down your power.

You don't need to fix anything yet. You just need to notice where [00:14:00] armor has become the default, and whether it's still protecting you or if it's just keeping you contained. You don't have to decide anything today. You don't have to make a plan. You don't have to push back, leave your job, or figure out what's next.

Just notice it. Notice how you walk into work. Notice where you're already braced before the first patient even walks through the door. Notice how often you assume the answer before the question is even asked, and ask yourself one thing: What is this costing me? Not in theory. Not in some future version of burnout. Right now.

Because medicine will keep taking what you let it take your time, your energy, your attention. But it doesn't get to take your agency unless you hand it over. And [00:15:00] most of the time that handoff isn't obvious. It happens in small ways in the name of being realistic, in the name of experience, in the name of getting through the day.

Medicine has already taken enough. It doesn't have to take the way you experience your own work or leave you feeling stuck inside it. 

Thank you so much for listening, and I'll see you next time on the Better Physician Life Podcast.