Being Comfortable Being Uncomfortable – A Medical Student’s Perspective

On February 8th, Lisa Rosenbaum published an excellent and thought-provoking piece in the New England Journal titled: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training. This article, and the accompanying podcast, has stimulated more conversation than a “non-research” article has in years. If you haven’t read the article, please do. It is truly a tour de force. Sensible Medicine is thrilled to be able to feature some articles reacting to, and expanding on, Dr. Rosenbaum’s work in the coming weeks. The first is from Nihar Rama, a medical student at the University of Chicago.

Adam Cifu

I still remember the email notifying me I was accepted to medical school. At that time, two thoughts occurred to me:

1) That perhaps I could give checking my email a short break (note: I didn’t);

2) That I was about to embark on a life-long journey, one I’d been informed by some was a privilege, and by others a curse.

Several years later, now deep into my medical education, I often reflect on my path. I know that many others would love to be in my position. Those who practice medicine enjoy a societal status that few others do. There is deference given to physicians and seemingly universal interest in what physicians do – much to Shonda Rhimes’ delight¹ – and I sense this week in and week out, even as a trainee. When those outside of medicine learn that I am a medical student, it is not uncommon for me to be met with, “Wow, I could never do that!” or “Gosh, you must have so little time!”

Learning how to practice medicine is not easy. There is a tremendous amount of information thrown at us. I am constantly balancing medical school coursework, exciting extracurricular experiences that enrich my learning and prepare me for residency applications, and personal relationships that keep me grounded. At times, though, it feels like I’m running out of energy and that too much is being asked of me. This feeling is not unique to medical trainees. Anyone developing a skill or portfolio at the beginning of their career works exceedingly hard to develop mastery of their craft, and that often takes a toll.

Yet, it seems that there is a palpable, unique shift in mindset amongst young medical trainees. In her piece Being Well While Doing Well – Distinguishing Necessary from Unnecessary Discomfort in Training, Dr. Lisa Rosenbaum, a correspondent for the New England Journal of Medicine, writes of the tensions between the rigor of medical training and how many trainees are pushing back against the demands of the profession. She writes, “…Maintaining our commitment to excellence while remedying our failures requires distinguishing unnecessary harms from necessary discomforts.”

It is a difficult distinction to make, and I sense that each of us have our own threshold for what we will and will not tolerate. Like many in my generation, my own tolerance is informed, in part, by social media and online discourse. In these digital spaces, it often feels that two extremes are overrepresented. On one end of the spectrum are the trainees described by Dr. Rosenbaum in her article and podcast. These trainees are keen to view the challenges of medical training as unnecessary harms rather than necessary discomforts; their online posts and videos generate hundreds or thousands of responses denouncing any perceived threat to their well-being.² On the other end of the spectrum are those trainees who post the highlights of their days – the exciting workshops they get to partake in, their successes or streaks on Anki,³ and the deep sense of pride and enthusiasm they have for the position they’re in.

I sympathize with both viewpoints. There is no doubt that discomfort is a natural component of medical training. After all, medicine is full of interpersonal interaction with difficult-to-navigate social hierarchies and power dynamics. I feel uncomfortable when an attending mispronounces my name.⁴ I feel uncomfortable when a patient asks me, “Where are you from?” and appends the question by commenting, “You have such a native English accent.” I feel uncomfortable that the systems-level challenges my patients face – impossible scheduling dilemmas, fights over insurance coverage, and the innumerable other barriers to high-quality, accessible, equitable healthcare – seem out of my control.

Some advisors are of the opinion that the types of situations described above are not a big deal. Others have counseled me to view mispronunciations of my name or questions about my accent as microaggressions and to push back against participating in a system that can, at times, feel uncomfortable. I recognize that some of my peers experience discomfort due to blatant discrimination and agree we must push back against those aspects of the profession. However, when I reflect on the demands of my training, from the hours I work to the people I interact with, I never feel I’m being harmed. The truth is that while I could choose to view the discomfort of being a medical trainee as trauma, I instead choose to view it as a natural part of my education that is indeed uncomfortable, but critical for me to able to navigate.

Uncomfortable situations often arise in high-stress settings with vulnerable people. Often, a seemingly racist comment is an honest mistake by someone who doesn’t know any better at the time: for example, if someone has never seen or heard a name before, how can they be expected to pronounce it correctly? Moreover, how does viewing discomfort as trauma affect how I care for others? To me, the discomfort in such situations is necessary if it means giving others the benefit of the doubt or being there for a vulnerable person in their time of need. As Lisa Rosenbaum writes, “At what point do exhortations to minimize our own discomfort compromise development of the skills necessary for tending to others’ suffering?”

Considering the two extreme views of medical training portrayed in online discourse, I more often identify with students who feel pride to be in our position. I’m reminded of this privilege every week when I interview a patient, perform a physical exam, and give an oral presentation to an attending physician. I view these moments as opportunities to add tools to my toolbelt as a future clinician and to become a more effective communicator. As someone who is an inexperienced patient interviewer, though, these encounters take a lot of time. They can also be filled with difficult topics, tears, and cultural missteps. Classmates have shared with me that they sometimes feel these experiences take time and emotional energy away from studying or from well-being. But to me, the discomfort that comes from these experiences are necessary discomforts that ultimately serve as reminders of why I’ve chosen medicine to be my future career.

Recently, I spoke with a patient who had stage IV lung cancer with metastasis to her brain and her spine. When I entered the room to speak with her, I noticed she was alone. I was also alone. At the start of our conversation, I felt uncomfortable. This woman was dying – what must that feel like?

What I had intended to be a 30-minute interview and exam turned into a nearly two-hour conversation. As the time passed, it struck me that despite her discomfort and ill-health, she was at peace. When I asked her how she had found peace in what many would consider to be a grim prognosis, she said, “Well, being comfortable being uncomfortable is part of the process. It sure is easier to be at peace when young people like you are willing to be here for me.”

I still ask myself whether being on this journey is a privilege or a curse. It is becoming increasingly clear to me that it is a privilege. While medical training can be uncomfortable at times, I believe it’s critical to remember that sometimes providing the key services patients need is a process – and being comfortable being uncomfortable is a part of the process.

1. Given the incoming 20th season of Grey’s Anatomy, it seems Shonda Rhimes has mastered the depiction of American medicine on TV – for entertainment purposes.

2. A YouTube search for “Why I’m leaving medicine” demonstrates the prevalence of commentary about the challenges of medical training, and why so many feel pushed to leave the profession. These trainees are not alone in feeling the struggles of medical training.

3. Anki: a flashcard application commonly worshipped by many trainees and abhorred by many others.

4. I sometimes worry that my gentle correction will turn into time marks 1:06-1:12 and 1:17-1:22 from this satirical video, though luckily I’ve never had this happen.

Nihar Rama is a medical student at the University of Chicago interested in pursuing a career in academic medicine. A Midwest native, he enjoys discovering new music/podcasts, playing basketball, and making people laugh.