The Myths That Keep Medicine Running

There’s a version of medicine that exists in the public imagination, and there’s the version of medicine that exists for physicians actively living inside of it. The gap between those two realities is often the seed of disillusionment. 

It doesn’t come all at once, of course. Most of the myths are absorbed so early and reinforced so often that they stop feeling like myths at all. They just become the background logic of the profession. The water everyone is swimming in.

Work hard enough and the system will eventually reward you.

Prestige compensates for poor quality of life.

Self-sacrifice is evidence of commitment.

Wanting more autonomy means patients will suffer.

Exhaustion is simply the price of doing meaningful work.

There is no way to meaningfully improve conditions without sacrificing quality of training.

Many physicians never pause long enough to examine where these beliefs came from, because medicine is structured in a way that discourages examination. There is always another shift, another patient list, another evaluation, another reason to delay the harder questions. And if those questions do begin to surface, they are often reframed as personal problems instead of structural observations.

But eventually, something starts to break the spell (hopefully the HC). Sometimes it’s watching a prestigious position offer compensation half that of a private practice job. Sometimes it’s seeing hospitals speak about physicians as interchangeable “providers” while simultaneously demanding total emotional investment in the mission. Sometimes it’s simply exposure to people outside of medicine - people with careers that allow for creativity, leverage, boundaries, mobility, or basic respect for their time.

And suddenly, things that once felt inevitable start looking…constructed.

A lot of the culture of medicine survives because physicians are trained to moralize their own exploitation. To view suffering as proof of seriousness. To interpret endurance as virtue. To believe that questioning the structure somehow cheapens the meaning of the work itself. To tell themselves that “I didn’t even have it all that bad.”

But meaningful work and dysfunctional systems are not mutually exclusive. A profession can matter deeply and still be organized poorly. An institution can save lives while also incentivizing unhealthy, unsustainable behavior from the people inside it. Healthcare can be separate from medicine. 

The mythology persists because it is useful. Prestige is useful. Guilt is useful. The idea that every generation must “pay dues” is useful. These narratives keep the machine running. And to be clear, many of the people reinforcing them are not malicious. They inherited the same stories themselves. They survived by adapting to them, and may not be able to imagine another framework. Others are too invested in the existing hierarchy to question it honestly.

But more physicians are beginning to notice the contradictions. And if you’ve been along for this ride at the HC, you are probably one of those physicians. 

They are realizing that medicine is not insulated from economics, power, branding, labor dynamics, or institutional self-interest simply because the work is noble. They are recognizing how often healthcare asks physicians to confuse gratitude with obedience. They are starting to compare medicine to other industries and asking why so many conditions once framed as unavoidable seem increasingly difficult to justify.

This shift in perspective can feel destabilizing at first. It’s not uncommon that a physician’s identity is completely wrapped up in being a physician. But once certain myths stop making sense, it becomes difficult to unsee how much of medical culture depends on them continuing to go unquestioned.

The moment physicians begin examining these inherited beliefs instead of reflexively defending them, new possibilities begin to emerge. Different ways to work. Different ways to lead. Different ways to think about identity, ambition, creativity, compensation, boundaries, and purpose.

Why are physicians consistently asked to absorb more administrative burden in the name of “professionalism”? Why is exhaustion framed as commitment while boundaries are framed as selfishness? Why are prestige and sacrifice celebrated so loudly, while leverage, ownership, and autonomy are treated with suspicion?

Let us be clear - this system is crumbling. Every drop is being squeezed out of physicians, benefitting neither the patients nor the workforce. 

So we ask one question today - who have you radicalized lately? And if the answer is no one, perhaps you are still treating these conditions as personal inconveniences instead of structural failures.

A Few Of Our Favorite 'Progress Notes' From May

You Can’t Eat Prestige

By Liz Malphrus, MD, MPP

I still, deep down, believe in the mission of academic medicine. But I've had enough jobs at this point to recognize how an industry shows you its true values: ignore what you’ve been told, and look at where the money is flowing. Caring for patients the way I want to care for them is my number one priority, and when I look at all of the complexity and inertia and obfuscation of these big academic bureaucracies, I know I can take better care of patients with more independence. That's how I ended up choosing private practice.

Residency Ends. The Conditioning Doesn’t.

By Frances Mei Hardin, MD

Medicine teaches many lessons worth keeping; discipline, responsibility, persistence, service, to name a few. But I am no longer convinced that relentless productivity deserves to be on that list. It may take me years to actually unlearn many of these habits, and you probably won’t catch me racing around on a bike any time soon, but I suspect that the most important skill I can develop is the ability to occasionally do something for absolutely no reason at all. And trust that my world will keep on turning even when I do.

ALIEN: The Threat Within

By Sacha McBain, PhD

Patients often describe the unnerving sense that something harmful was unfolding internally long before systems around them fully recognized it. Alien repeatedly amplifies this anxiety. As screenwriter Dan O'Bannon once observed, the film’s terror emerges less from the monster itself than from the waiting in between. It is the stretches of uncertainty where characters talk, plan, and attempt to return to normal while sensing that something terrible may still be approaching

Crying In The Bathroom: On What We Forget About Residency

By Liz Malphrus, MD, MPP

I've cried in bathrooms for a lot of reasons throughout residency: acute-on-chronic stress, feelings of inadequacy, the relentlessness of morbidity, and just plain exhaustion. What got me this time was this: no matter how much you give of yourself to residency, it will never be enough. We are all highly replaceable, and systems and institutions won’t ever love us back.

How Do I Stay Confident When I Feel Like The Least Experienced Person in the Room?

By Iya Agha, DO

Ask the question, even if you think it might sound basic. Offer an answer, even if you’re not completely sure. Take opportunities to try things instead of waiting until you feel fully ready. Because that “fully ready” moment doesn’t really come.

Your Podcast Binge List

We linked some YouTube and Spotify pages for you, but click here to listen to any of our shows on the platform of your choice.

• Social Rounds - Tony Chin-Quee, MD, Frances Mei Hardin, MD & “Cartographer Geoff” - Big Map Conspiracies, Victorian Cholera, and Finding Work You Actually Love

• Fem MD - Lauren Umstattd, MD & Natalie Krane, MD - "Even Baddies Get Saddies" - Women Surgeons, Stress & the Athlete Mentality

• Surgeons with Purpose - Mel Thacker, MD & Dr. Red Hoffman - You’re Not Stuck

• Surgeon, Interrupted - Frances Mei Hardin, MD - “Why Are All the Doctors Leaving?” | Residency, Hyper-Productivity & the Inability to Rest

• The Other Human in the Room - Joan Chan, MD - Humanizing Medical Education - Part 1

• Cut & Tell with Dr. Liz Malphrus | Residents Are Being Exploited (And Everyone Knows It)

Explore Our Growing Podcast Network

Here’s what’s live and ready for your next commute, call-room break, or coffee run:

• Social Rounds - Tony Chin-Quee, MD + Frances Mei Hardin, MD

• Fem MD - Lauren Umstattd, MD

• Surgeons with Purpose - Mel Thacker, MD

• The Other Human in the Room - Joan Chan, MD

• Surgeon, Interrupted - Frances Mei Hardin, MD

• Cut & Tell - Liz Malphrus, MD

Want to Get Involved?

Since launching, we’ve been blown away by how many physicians have reached out asking, “How can I get involved?”

Here’s how:

• Submit your writing for consideration on our blog

• Pitch us a creative idea or original column

• Apply to be a guest on a podcast

• Follow us and share our content on Instagram, TikTok, and YouTube 

The Collective only works because of voices like yours, and there’s always room for more.

Until next month,
The HC Team

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