It's So Hard...

If you grew up in the 1990s, is your brain already singing the next line?

If you work in medicine, the phrase takes on a different meaning. Spend enough time in medicine and you’ll hear those three words in some iteration almost every day.

“Our jobs are so hard.”

“It’s so hard to keep up with documentation.”

“It’s so hard to recruit faculty.”

“It’s so hard to meet RVU expectations.”

“It’s so hard to avoid burnout.”

“It’s so hard to practice medicine the way we know it should be practiced.”

None of those statements are wrong, In fact, many of them are painfully true. But lately, I have been wondering if those words are crowding out something else that is essential to the practice of medicine. Focusing on what is ‘so hard’ naturally creates a survival mindset. When that becomes the dominant story we tell ourselves, the practice of medicine starts to feel like something to endure rather than a craft to pursue, and it becomes difficult to say other important things out loud:

“Medicine is a craft worth mastering.”

“Becoming a clinically exceptional physician is still one of the highest aspirations of our profession.”

“Serving patients with extraordinary clinical skill is foundational to equity.”

But is it even possible to inhabit a difficult profession without slipping into survival mode? Then I found an unexpected example: Boyz II Men.

I have a confession that would surprise most people I work with: over the past few months, I’ve spent an embarrassing number of hours watching Boyz II Men clips and interviews, catching up on what became of them after the year 2000. I expected mostly adolescent fangirl nostalgia. What surprised me was finding three professionals more than thirty years into their careers who no longer had anything left to prove but, even long after the spotlight had moved on, continued to approach every performance with the same sense of purpose they had when the world was watching.

There was no irony, no distancing themselves from their own success, no pretending this was ‘just a job’, no cynicism about singing the same song in an unglamorous venue for the 10,000^th time. Instead, they spoke with an unapologetic sincerity about the responsibility they felt towards the people who chose to spend an evening with them. They could have focused on everything that had become so hard: decades spent living out of buses and hotel rooms, singing the same songs thousands of times, aging in an industry obsessed with youth, and watching popular music move on without them. None of those realities would have been untrue. But they refused to let those things become the defining narrative of their profession. Instead of letting all the things that had become so hard also harden them, they chose instead to organize their professional identity around the privilege of what they had been trusted with, some of the most precious memories of other people’s lives.

They understood that every performance carried emotional weight. Their music had become woven into weddings, first dances, heartbreaks, funerals and countless private moments they would never witness. Recognition of that trust compelled them to continue honing their craft rather than becoming jaded by reality. They believed that being entrusted with something so precious called them to bring their very best, night after night.

Watching them made me realize that what sustained them wasn’t simply fame or talent. It was a particular understanding of professional responsibility.

My profession is obviously quite different from theirs. The stakes are different, the responsibilities are different. But at their core, both professions depend on people choosing to place something precious in our hands. And across our professions, we face the same choice: whether to let the realities of the work harden us, or to remain anchored in the purpose and craft that allow us to honor what has been entrusted to us.

In medicine, what is entrusted to us is very different. Patients invite us into some of the most vulnerable moments of their lives: the day they hear the word ‘cancer’, the night they cannot breathe, the morning someone has to decide whether to let go of the person they love. As physicians, we are entrusted with experiences we did not create but are privileged to help carry. The only adequate response to that kind of trust is a lifelong commitment to becoming better at our craft. Not because perfection is possible, but because our patients entrust us with what is most precious: their bodies, their futures, and sometimes even their lives. They deserve the very best we are capable of bringing to them.

With this realization came a nagging question: if entrustment calls us to continually refine our craft, why do we as a profession spend so little time talking about the craft itself? Why has clinical craft become oddly absent from center stage in our professional conversations?

And by craft, I do not mean technical skill in isolation. I mean the lifelong discipline of thoughtfully bringing together scientific knowledge, clinical judgement, communication and compassion in service of the person in front of us.

I worry that our focus has slowly drifted without us noticing. The realities of practicing medicine, especially in resource-constrained settings, are so demanding that we naturally gravitate toward talking about the systems surrounding clinical care. Burnout. Staffing. Policy. Structural inequities. Those conversations are essential because they address real barriers to excellent care. But they are also problems that no individual physician can solve alone.

Over time, I worry they have crowded out conversations about the one thing over which every physician still has meaningful agency: continually refining our craft. And when that happens, we lose more than opportunities to improve – we lose one of the primary ways physicians stay connected to the purpose of our profession.

Where are the conversations about how we approach becoming better diagnosticians? Better at understanding and applying evidence at the bedside? Better communicators with our patients? Where are the conversations that leave you thinking, ‘Wow, I can’t wait to try that on rounds tomorrow?’

The conversations that occupy center stage eventually become the culture of our profession.

In resource-constrained settings, where many of the greatest barriers to good care are structural, conversations about clinical craft can feel like they miss the point, or even distract from the work of advancing equity. But no matter how profound the structural barriers, every patient still entrusts us with the immediate problem that brought them to us.

That is why I wonder if we have it backwards. Perhaps excellence in our clinical craft is one of the ways equity becomes tangible for our patients. Patients do not experience equity as an abstract principle. They experience it when the right diagnosis is made despite an atypical presentation, when a medication choice reflects careful consideration of their priorities and circumstances, when a frightening diagnosis is explained with clarity and compassion. Equity requires many things – fair systems, access to care, adequate resources and sound public policy. But at the bedside, equity becomes tangible through excellent clinical care. Bringing the very best of our craft to the bedside, day after day, in unglamorous venues whether or not anyone is watching, is one of the ways equity becomes real for our patients.

Watching Boyz II Men reminded me that reality and purpose are not mutually exclusive. Difficult professions do not inevitably become cynical ones. Medicine is hard. Systems are strained. Burnout is real. None of those things should be minimized. But neither should they become the defining story of our profession. ‘It’s so hard’ cannot be the only story we tell about ourselves about our profession. Continually refining our craft is not elitist, nostalgic, or somehow at odds with equity. It is how we honor the trust our patients place in us.

If conversations shape culture, then all of us have some responsibility for the culture of our profession. For those of us in leadership, that responsibility includes deciding what conversations deserve center stage. As a division chief, I don’t want our faculty meetings to ignore operational realities. Those realities deserve our attention. They just don’t deserve our entire identity. I do not want those realities to become the only story we tell about ourselves. I want people leaving our meetings talking about a diagnosis that changed how they think, a colleague who inspired them, an evidence-based innovation that made care better, a patient who reminded them why this work matters.

I want us to celebrate our greatest hits, not because we’re nostalgic for some golden age but because our patients still come to us for the same reason audiences still come to hear Boyz II Men. They are placing something precious in our hands, hoping we will bring them our very best.

Boyz II Men have spent more than thirty years refusing to let some the realities of their profession eclipse its purpose. They continue to refine their craft because they believe the people who entrust them with life’s most meaningful moments deserve nothing less than their very best. I wonder what it would look like if medicine intentionally embraced that same ethic, one in which bringing our very best to the people who have entrusted us with what matters most to them never goes out of style.

Medicine has always been hard. Maybe what has become even harder is remembering why it was worth committing ourselves to this work in the first place, and refusing to let ‘it’s so hard’ become the only story we tell ourselves about our work.