I recall the initial instance when I felt shamed for posing a question. It occurred during my OB/GYN clinical rotation in PA school. I inquired with my attending physician about a patient, not from a place of laziness, but because I truly required clarity. However, instead of providing guidance, he dismissed me. “You should conduct your research. You should be informing me about the patient, not the other way around.” I grasp his perspective, but in that instance, I realized that if I encountered an issue, I had to resolve it independently. Support wasn’t present. And seeking assistance? That was perceived as a weakness, not a strength.

This wasn’t a singular occurrence. It was my initiation into a professional environment where silence is encouraged, composure is anticipated, and the need for help is something that becomes concealed.

Consider this. From the first day of clinical rotations, we learn to stifle the very instincts that make us human. Fear, uncertainty, and emotional reactions are tucked away and substituted with protocol, efficiency, and calm execution. Don’t misunderstand me—I comprehend the rationale. In numerous aspects, it’s a vital adjustment. You can’t crumble during an emergency. You can’t freeze before a patient who is deteriorating. Health care requires a distinctive combination of precision and presence amidst chaos, which necessitates override. But that override transforms into a routine.

We come to suppress our F3 (fight-flight-freeze) response, not solely in emergencies but within ourselves. We develop the habit of persevering regardless of circumstances. We don’t reflect on whether something is sustainable. We merely push through because that’s our training. Because that is what is optimal… right?

The peril is that these same qualities that render us effective, respected, and frequently admired can also render burnout imperceptible. If we are too capable to be seen as struggling, too composed to warrant concern, too independent to request assistance, fertile ground is created for burnout to take root.

Before becoming a PA, I was an EMT within New York City’s 911 system. I recall being taught at the FDNY academy that children are remarkable compensators. My instructor remarked, “Don’t let the appearance of your pediatric patient fool you, even if they seem fine given the chaotic circumstances. Kids can compensate incredibly well… until they fail to do so. When they decompensate, it happens swiftly and severely.” Similarly, burnout does not always manifest as outright collapse. More frequently, it appears as quiet endurance. And by the time the warning signs emerge? We have internalized the conviction that we should already be equipped to respond, that we ought to be able to remedy it independently.

This, however, fosters a complex culture in health care. Individuals trained under this culture of stoicism decades ago are now our attending physicians, supervisors, and administrators.

The message they received—“resolve it independently,” “avoid complaining,” and “display no weakness”—was never re-evaluated. Consequently, intentionally or not, this mindset is perpetuated. New clinicians step into established paradigms. Thus, the cycle continues. I have witnessed this firsthand. I have experienced it. And I have collaborated with numerous health care professionals to know that I am not alone.

A recent burnout survey involving 2,000 U.S. adults indicated that younger generations, particularly millennials and Gen Z, reported reaching their highest stress levels around age 25. Although the study wasn’t specific to healthcare, the trend signifies a broader cultural transformation indicating that people are experiencing burnout at younger ages and more rapidly.

If a 25-year-old outside of medicine is under such pressure, it would be naive to assume that someone in healthcare at the same age is experiencing less. On the contrary, the demands of clinical training, emotional suppression, and the relentless pressure to perform significantly heighten the risk of burnout compared to their peers in non-medical roles. The challenge is that burnout rarely announces itself with glaring signals. It typically appears quietly, accompanied by subtle alterations. A change in demeanor. Difficulty focusing. A sense of detachment. What we clinicians may classify as “non-specific symptoms.” In such cases, burnout is not only challenging to identify—it’s difficult to acknowledge.

When we present patients with a diagnosis that takes them by surprise, particularly one they are reluctant to accept, they frequently respond with rationalizations. “But I eat healthily.” “But this doesn’t run in my family.” “But I’ve experienced this before, and nothing occurred.” That may all be accurate, but it doesn’t alter what we observe.

Over the years, I’ve observed something, both in practice and while assisting health care professionals confronting burnout. A similar phenomenon often transpires with us regarding burnout. We convince ourselves we are simply fatigued, that it is merely a busy period, that we can manage it. We recognize the signs, we understand.