Almost daily, a doctor shares with me a variation of the same sentiment.
It might express frustration about metrics, fatigue, or the lack of administrative clarity. Yet beneath it lies something deeper:
“I am mourning what I wished medicine would become.”
When this phrase is articulated openly, without defensiveness, a transformation occurs.
The anguish transitions from flaw to significance.
In existential contemplation, grief is not a sign of weakness. It reflects attachment. We grieve for what we cherished, what we committed ourselves to, what we thought would last. When a physician laments for medicine, they are not only reacting to workload or policy. They are grieving an internal promise. The envisioned future where medicine would be a vocation instead of a commodity. The future where technical excellence and ethical purpose would complement each other. The future where skill and compassion would not clash.
Identifying this grief brings back coherence.
When unvoiced, the distress often manifests as irritability, detachment, cynicism, or what the literature terms burnout or moral injury. Those phrases capture important aspects of physician distress. However, they may not always tap into the essence.
At the heart lies a clash between expectation and actuality.
Early in their career, a physician weaves a narrative of who they are becoming. This narrative organizes sacrifice, debt, geography, relationships, and even identity. It carries the assurance that the labor will validate the expense. When real life no longer reflects that aspirational vision, something destabilizes. Not due to the fragility of the doctor, but because the guiding narrative has splintered.
Viktor Frankl noted that despair arises when suffering lacks meaning. He suggested that while difficulty itself is bearable, difficulty without understanding is intolerable. A physician toiling long hours for a cause they believe in might feel drained yet aligned. However, the same hours in conditions that seem transactional and misaligned may leave them feeling hollow.
Naming grief reinstates meaning.
It also distinguishes identity from institution. When a doctor states, “I am grieving what I hoped medicine would be,” they are no longer implying, “I am flawed.” They are conveying, “Something I valued has shifted.” The linguistic distinction is minor. The psychological distinction is profound. The former cultivates shame. The latter encourages reflection.
There is also a moral aspect. Numerous physicians entered the field with ethical aspirations: to alleviate suffering, to belong to a profession governed by shared ethics, to operate within a community of trust. When commercial pressures, algorithmic metrics, or unclear administrative directives disrupt that moral cohesion, the distress is not solely emotional. It represents ethical confusion. The grief indicates a misalignment between values and quotidian actions.
And once recognized, grief can be assimilated.
Mourning does not suggest returning to a previous time. It signifies integrating loss into a reevaluated self-concept. The doctor who acknowledges that medicine no longer aligns with their initial vision is liberated from the draining attempt to force reality back in sync with that ideal. Energy that was once spent resisting can now be directed toward adaptation.
This is not giving up. It is gaining clarity.
Clarity invites new questions to emerge. If medicine is not as I envisioned, what is still worth preserving? Which elements of my profession are transferable across systems? What does integrity signify under current circumstances? These inquiries shift the physician from being a passive bystander to an active interpreter of systemic changes.
In this regard, maturity encompasses enduring ambiguity without succumbing to cynicism. Institutions change, sometimes regress. Identity must be sturdier than structure. A physician who can openly grieve is less likely to completely tie their self-worth to their professional situation. They are capable of holding both disappointment and commitment at once.
There is hope embedded within this. Not an optimistic view of the system. An empowered perspective of the self.
Once the loss is acknowledged, response becomes feasible. Some adjust their practice styles. Some advocate for reforms. Some narrow their focus to what they can influence. Some leave clinical medicine but keep the healer’s identity in new forms.
The shift is subtle yet significant.
Despair pronounces: This is futile, hence I am diminished.
Grief asserts: This was significant to me, and its transformation hurts.
One undermines identity. The other preserves it.
When grief is articulated, especially among colleagues who understand the medical culture, isolation diminishes. The distress is contextualized rather than perceived as personal failure. It becomes part of a larger narrative.
And when suffering is part of a narrative, it can be revised.
Not cured. Not eliminated.
But carried in a new way.
After decades in medicine, and years spent listening to physicians share their private frustrations, I have come to this belief: When a doctor can clearly articulate their grief, free from self-blame, they are already less adrift than they believe.
And sometimes that acknowledgment is sufficient to continue.
Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. He trained at Westminster Hospital Medical School in London and practiced for decades in both the U.K. and the U.S. before shifting his attention from surgical procedures to emotional well-being.