Education And Debate Coping with loss

The doctor's losses: ideals versus realities

BMJ 1998; 316 doi: (Published 18 April 1998) Cite this as: BMJ 1998;316:1238
  1. Glin Bennet (, formerly consultant psychiatrist, United Bristol Healthcare NHS Trust
  1. 44 Wellington Park, Bristol BS8 2UW

    This is the sixth in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice

    After five years of study, newly qualified doctors may find it hard to realise that much of their future development will involve loss. They will go on gathering information and acquiring skills, but if they are to retain their enthusiasm and to mature as people, they will be learning to live with various losses.

    Summary points

    Reality often disappoints the expectations of young doctors, who become tired and disillusioned with themselves and with the health care system

    A plateau in middle life is often associated with loss of further opportunities, and high achievers may interpret this as failure

    To enjoy medicine we must achieve a balance between meeting the needs of our patients and maintaining our own resources of strength, energy, and commitment

    Doctors who can acknowledge their own fallibility, accept their own wounds, and accept help from colleagues or others may emerge warmer and more humane


    New doctors should enjoy the initial enthusiasm, the ideals and the sense of omnipotence and invulnerability, the buoyant feeling of being able to contribute to the general good, because it may not last for long. Very likely a few months of broken nights will blur the ideals and push the ambitions into the distance. The immediate objective becomes to get through the job.

    The grinding tiredness teaches them a lot: about their limitations, that sleep matters, and that it is difficult to be a good doctor when their eyes will not stay open. They become impatient over explanations, and tiredness comes up like a barrier so that they can no longer reach out to anxious and grieving patients.

    They are learning that they cannot meet the ideals they set for themselves …

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