Emotions Need Space: A Physician-Mentor’s Message to Medical Students

From the July 7, 2023 issue of the Transformational Times

Emotions Need Space: A Physician-Mentor’s Message to Medical Students 

 

Brett A Linzer, MD 

 

 

Dr. Linzer, a practicing physician in Oconomowoc, WI, has medical students rotating through his office to learn and observe. He encourages students to "let go of the mask and persona" and allow "their vulnerable and emotional selves to emerge." Now that the academic year is in full swing, he offers a story and some solid advice ...

 

I have had the privilege and honor of coaching and mentoring medical students for 21 years. 

 

Most of this mentoring takes place in my outpatient Internal Medicine / Pediatrics practice, where each student spends two to three days with me every week for a month-long rotation. Additionally, I have been fortunate enough to work with students from all years as a facilitator in the REACH and 4C Coaching programs. Throughout these experiences, I have accumulated over 16,000 hours of one-on-one time with students in my clinic, fostering deep connections and intimate relationships. 

 

During extended periods in my clinic, I encourage students to shed the facade of a medical student who must appear knowledgeable, confident, and unemotional. I ask them to remove their white coats and approach patients with just their name tag and stethoscope. Over time, I help them feel comfortable enough to let go of the mask and persona they wear, allowing their vulnerable and emotional selves to emerge. Gradually, I witness them soften their demeanor, speak more thoughtfully, take time between their thoughts, and smile more often. This process nurtures the growth of trust and connection. 

 

What students tell me

One question I make a habit of asking each student: What is the most challenging aspect of medical school for you?  

Sometimes, their responses revolve around academic difficulties, fear of missing an important diagnosis, or lack of sufficient knowledge. However, with patience and gentle encouragement, we often arrive at deeper and more meaningful answers. They share personal struggles such as balancing academic responsibilities with a sick family member, coping with depression and anxiety, feeling isolated, perceiving everyone else as having it all figured out, grappling with imposter syndrome, or struggling with intense emotions following traumatic experiences. 

 

While I don't possess all the answers to these challenges, I believe that empathizing with their experiences and being present for them is helpful. In some small way, I hope that by being there for them, they will feel less alone and broken, just as I once did.  

 

I have discovered that fostering trust and openness requires me to lead by example, demonstrating vulnerability and openness in my own journey. I like to share personal stories. Some highlight my successes and achievements, but the most impactful and relatable tales are those where I made mistakes or faced emotional challenges.  

A patient and an interaction I will never forget

One such story, which resonates with many, revolves around my experience as an early third year medical student during my first inpatient rotation. Filled with enthusiasm and a desire to please, I was part of a team that admitted a middle-aged man with a new diagnosis of pancreatic cancer. Before rounds each morning, I would talk with this patient as I gathered the clinical information and performed a short physical exam. He shared details about his family and teenage children. I knew he had a grim prognosis and I felt fear and sadness for him and his family. 

One day, during rounds with our team, I allowed a glimpse of my emotions to surface.  

 

The response I received from my senior resident affected me for many years. He stopped rounds, directed his attention at me, and loudly proceeded to publicly humiliate and shame me, declaring that physicians must remain clear-headed and unemotional, detached from their emotions to ensure patient care is unaffected.  He demanded to know whether I understood what he was saying. I looked down, softly said yes, and experienced some relief when he resumed rounds. 

 

In the following days, I pondered the true essence of being a doctor. The residents, including my senior, served as my role models and cultural leaders. I questioned whether abandoning my emotions was the right path or if there was room for both intellectual clarity and emotional compassion. It seemed like I had to make a choice between their perspective and my own. After all, they were experienced physicians, while I was only an aspiring one. 

 

As I advanced in my training and subsequent practice, I suppressed and numbed my emotions, seeking refuge in my intellect and self-shaming whenever strong emotions arose. Unfortunately, this approach complicated my relationships with myself, my wife, my children, my colleagues, and my patients. 

Finding healing; Learning that emotions need space

 

In 2013, during a particularly challenging phase in my life, I sought guidance from a physician coach. Through this experience, I discovered that many of my behavioral patterns and subsequent emotions were a direct result of my medical conditioning. More importantly, I realized that I wasn't broken or alone. Emotions, I came to understand, are an integral part of being a complete human being and a successful physician. 

 

I also recognize the significance of finding and creating a dedicated space to process intense emotions. While the acute setting of the ICU or the fast-paced emergency room may not be suitable--clear-headedness, decisiveness, and control are paramount--I needed to look elsewhere.  

 

I found this space among trusted friends, coaches, my wife, and circles of supportive peers. This space, characterized by trust, uncertainty, and honesty, allows me to fully experience intense emotions such as self-doubt, sadness, self-judgment, shame, as well as the joy of living a fully engaged life. 

 

As physicians and medical students, we willingly put ourselves in situations where people may face their most challenging life experiences, relying on us for assistance and support. This work holds profound meaning for me, but it requires intentional effort to acknowledge and process my own emotions. Only then can I consistently show up as a grounded, clear headed, open-hearted, and supportive presence for my patients, family, coworkers, and myself. 

 

My advice: Find mentors and embrace your humanitiy

As you embark on your own journey as medical students and future physicians, it is crucial that you find your own path. I encourage you to seek out individuals you trust to accompany you along the way, whether it be a therapist, a friend, a support group, a physician mentor, a coach, or someone else.  

 

You need a space where you can fully embrace your humanity. The culture of medicine is changing, but not fast enough. There are still numerous role models who resemble the resident I mentioned earlier. I hold compassion for that resident and hope he found a path of healing. 

 

The journey is not easy, and even after 30 years in medicine, I continue to learn and grow. 

 

If you are looking for a space to write about your emotions or your experiences, please consider reaching out to me by email. I promise you I will read it and respond. I would be honored to connect with you.  

 

Dr. Brett Linzer, MD, is an Internal Medicine/Pediatrics physician in Oconomowoc. Additionally, he serves as a coach specializing in guiding medical students and physicians to embrace their complete humanity in both their personal and professional lives. He can be reached at balinzer1@gmail.com 

 

 

Apprenticeship in Medicine 2023: My First and Last Class

From the August 25, 2023 issue of the Transformational Times - SPARCC and AIM focus

AIM 2023: My First and Last Class 

Nadia Tabit, Class of 2026 

 

 
A medical student who, as a high school student participated in MCW summer enrichment programs, reflects on the valuable lessons she learned this summer from high school students she mentored in MCW’s Apprenticeship in Medicine (AIM) program…  

 

During a medical school interview, my interviewer asked, “What would you do if you did not get into the program?” By the time this question rolled out, the little voice inside my head had already died, and every question was beginning to sound like a trick question. Was her question meant to test my unwavering commitment to the medical field, or did it hold a different purpose altogether? Maybe she was hinting that we will not always get to be just one thing in life, even if we choose a single career and train for it. To say there was no other role I could picture myself in would be a lie. 

 

If you tell a high school teacher you are considering teaching high school, they will beg you to explore other options. Despite their best efforts, I still think I would have enjoyed being a high school teacher. A teacher because I love the psychological component of working with young people as they navigate a year in their lives. High school because I remember it as a time when I needed someone to have faith in my potential before I set off into the world to do it on my own. Interestingly, this past summer gave me a unique opportunity to do that.  

 

For the last seven weeks, I was privileged to co-lead MCW's Apprenticeship in Medicine (AIM), a dynamic six-week summer program designed for historically underrepresented local high school students.  

 

Applying for this position felt like a full-circle moment for me. I previously participated in CTSI 500 Stars and SPARCC (Student-centered Pipeline to Advance Research in Cancer Careers) in 2019 and 2020. These summer enrichment programs at MCW were invaluable to my acceptance to medical school. It was an immense honor to be part of these programs once again, but this time in a leadership capacity, guiding students on their own journeys. 

 

The goal of AIM is to jump-start students’ early engagement and proficiency in medicine and preparation for the wide professional world. Students balanced a demanding human body systems curriculum with weekly clinical shadowing across various specialties.  

 

Initially, the intent revolved around the five of us, current medical students, tackling the roles of teacher and mentor for our students. But anyone in the field knows that what makes a good teacher is knowing when to be the student. I soon realized I would be learning more from them than they could have learned.  

 

Here are a few of my takeaways: 

 

1. Our students were fearless – and I should be, too. 

2. 
   

They say a classroom is a microcosm of society, and within its walls, you will encounter tiny yet profound acts of bravery. Students who step into the spotlight risk the possibility of failure, students who engage in discussions about challenging subjects, and students who embrace leadership roles. 

 

On the final day of class, MaHailey surprised me with a card, and in her second-to-last sentence, she wrote, “If you ever need an inner voice that is more authoritative, just think of me lol.” The sentence was a lighthearted reference to a conversation we had weeks earlier about my struggle to assert authority for fear of alienating others – the age-old “people-pleasing” problem. MaHailey, who stood out as self-assured and wise beyond her years, reminded me that the alternative to not speaking up is alienating yourself. Her words have been enduring – whenever I need a nudge to advocate for myself and those nearby, I draw courage from her words. 

 

2. It always pays to see the best in everybody.  

3. 
   

You will encounter talkative students who create a ruckus in the classroom and reserved ones who hardly utter a word. Some students aim for A’s while others are satisfied with any grade they achieve. Amidst these diverse personalities, you come to appreciate that everyone possesses something special, regardless of how different they are from you or each other. It is crucial to recognize that quiet students are not disinterested learners, and those not fixated on achieving top grades are not underperforming. Their learning approach tends to be more practical and aligned with their needs. 

 

3. Give your students the freedom to choose.  

4. 
   

I discovered that giving students real classroom choices — having to do with the assignments they complete, the peers with whom they work, or even the music they play during study hall — directly impacted their engagement and motivation. Real learning thrives when students have real choices because it demonstrates that you respect, trust, and encourage them.  

 

4. I was so proud of my students that it made me proud of me.  

5. 
   

As AIM concluded, our students developed an abstract and delivered a formal oral presentation about a disease/condition of their choice. To say I was beaming with pride while watching them present is a gross understatement. Zaynab masterfully employed storytelling to teach us about synesthesia. Vuk's depth of knowledge on Alzheimer's made him seem like a world-renowned researcher. Khamani's presentation is best described as cool, calm, and collected. He handled every spontaneous audience question with unwavering composure. While their talents were not influenced by me or the content I taught, I became so proud of their achievements that it also made me proud of myself for being in a position to witness them.  

 

5. Above all, be kind. Your students will remember you the most for it.  

6. 
   

You may think you are just doing a job, but the people around you notice who you are. Years from now, your students will not remember what you said or did. Your impact lies in the way you made them feel, and the kindness you extended, even during moments when it might have been a struggle to do so. 

 

Someone recently asked me a question that resonated with me: “What brought you the biggest joy during your M1 year?” I loved how they did not ask about mere fun or enjoyment but instead focused on unadulterated joy.  

 

It was not the OSCEs or the cloud of anxiety that often accompanied the first year of medical school that brought joy. Instead, joy came to me in the form of 29 students who graced me with a lightheartedness unlike any other. Their laughter, insights, shared music, and spirited card games collectively created an atmosphere of genuine joy that any other experience could not match. 

 

Perhaps in a different life, I am a high school teacher guiding a group of 29 students. Among them, seven are pleading for extra credit on our Friday quiz. There are two musically inclined souls DJ-ing our class Spotify playlist. One brave student is tackling the Sunday New York Times crossword (and only one because those are impossible). On Thursday, we are using a balloon and ping pong to demonstrate the effacement of the cervix during labor. Friday, we leave 30 minutes early just because it is a Friday. Come Monday, we are both dreading and excited to do it all over again. 

 

To our AIM students Class of 2023, I am so proud of you. 

 

Nadia Tabit is from Milwaukee. She is a second-year medical student at MCW-Milwaukee and is working alongside Dr. Kristina Kaljo on a project to develop a comprehensive health curriculum for adolescent students in Milwaukee. In her free time, she enjoys reading, scrolling through Pinterest for hours, and spending time with her large and loud family.