“We all wear masks, and the time comes when we cannot remove them without removing some of our own skin” –​ André Berthiaume

October 30, 2019

I recently visited the home of past president, Dr Granger Avery. As I admired his incredible collection of masks, I was reminded of the significance of such masks in many cultures around the world. Some are designed to represent deities to be looked up to or, in some cases, feared in an effort to support community or cultural values. Others may simply be characters of legend used to portray verbal histories or experiences. Masks depicting demons or otherworldly spirits can be used to assist in the grieving process of families or communities, when someone important is lost and needs to be encouraged to move to the next world. In turn, this supports those left behind to move forward with their lives, secure in the knowledge their loved one is at eternal peace. Some masks cover only part of the face, and others may be designed to hide the face of the wearer to ensure that the message is felt to be conveyed by a higher spirit, such as those masks worn by shaman. After my visit with Dr Avery, I found myself reflecting on the masks that we wear as physicians.

President's%20BlogI believe each of us has a series of metaphorical masks that we don as we pass through the various stages of our day to day lives, and stages in our careers. Child, partner, parent, grandparent, learner, teacher, expert, helpless or helpful, they all serve a purpose. In a more literal sense, we train physicians to wear special masks to ensure success in healthcare delivery. Along with the various other pieces of armour we wear, such as surgical scrubs and lab coats, our masks serve as an outward sign to those around us about what our specific roles are. The strong, at times stoic, mask of the surgeon instills a sense of confidence in patients that we are not afraid, and we will ensure their safety.

There are certain masks we design to shield ourselves from the grief we experience caring for patients in critical or unresolvable situations. Yet, how do we reconcile these masks with what is really going on underneath? We are after all, just as human as those we treat. Many colleagues have shared with me that a major source of their sense of burnout stems from the difficulty taking off the “physician” mask at the end of the day, and putting on the “family” one. They just don’t have anything left to give. As physicians, we know we are most effective when we connect human to human with our patients. On the other hand, we also need to be able to withhold some portion of ourselves to stay healthy and effective in our personal lives. 

Do we ever truly stop being doctors as we go about our lives? I like to think we should, as I feel we need to be successful in both our personal and professional lives to feel content. At the end of our work day, we should be able to walk away with some energy left for ourselves and our families, putting behind us all things medical. But, how many of us will actually turn off our phones and pagers, or refuse to take that call back message when we are needed at the end of a shift? One of the leading causes of burnout has been identified as unrealistic expectations from patients and our healthcare system. What role has our collective outward mask told others to expect from our profession? I believe we have worn the mask of tireless warrior for far too long. The cracks are forming in our masks and we are at a loss as to how to keep them glued together. 

Perhaps by opening up a conversation about the masks we wear, and the burdens we face daily as physicians, we can begin to find more of a balance between our professional and personal lives. By revealing more of our humanity, we could begin carving a path towards a more truthful representation of our experiences.

- Dr Kathleen Ross

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