Jillian Horton is a physician and the author of We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing.
Canadian medical schools will admit more than 3,400 future doctors this fall. These eager young students will attend White Coat ceremonies – formal events where they don symbolic garb and frequently recite the Hippocratic Oath. There, they will listen to someone like me – a physician for 26 years – give life advice on practising medicine. Their proud parents will take photos, shared with happy hashtags and feel-good messages about everything that lies ahead.
But these students are not entering a feel-good, happy-hashtag world. Between their first day of school and graduation, they will be pummelled with headlines about a system in crisis and a work force facing burnout and despair. Even the hottest pop-culture take on practising medicine in 2026 is a brilliant phenomenon that literally portrays the field as a pit. These future doctors are beginning their careers as medicine grapples with the fallout of a global pandemic – and at a time when misinformation, disinformation and AI are radically transforming our profession. Some white coat ceremony speakers will likely use that same AI to generate their remarks. Others – purists – will write their own words of wisdom. But in light of the current state of medicine, at least some students will wonder how relevant that “wisdom” even is.
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They have every right to wonder. We, their teachers, are the perceived stewards – or at least custodians – of this broken system. How can we tell them to “put patients first” when reality consistently obstructs us from doing any such thing? How can we champion the pursuit of “excellence” without simultaneously acknowledging that the crumbling infrastructure of health care often reduces that pursuit to a punchline? And how can we tell them to be serious advocates for change when even our own organizations sometimes try to silence, penalize or punish those who speak about these problems publicly?
These are important questions. But they are not – cannot be – our only questions about medicine, or life within it comes to feel hopeless.
Seven years ago, I started teaching an intensive seminar for fourth-year medical students at the University of Manitoba. It’s called “Mindful Practice,” but the name doesn’t really do it justice. It focuses on self-regulation (learning to manage your emotions and reactivity when you are under pressure) but also on deep questions of meaning and purpose in medicine. The class is a rare opportunity for me and some very bright students to explore in depth why we do what we do, and to reflect on the many inherent – often painful – contradictions of medical education and practice. The course is based on a rigorously studied, JAMA-published program out of the University of Rochester. I accept 12 students, and it lasts for three weeks. Every kind of question, reflection and challenge about medical training and practice is welcome. It is the highlight of my academic year.
Let me say upfront that despite having written a book about its impact on my life, “Mindful Practice” sounds like a class I’d have been inclined to skip. As an expert in health care worker well-being, the mantra I repeat most often is this: the primary drivers of burnout are organizational and system factors. Primary drivers do not include health care workers’ lack of “mindfulness” or low levels of resilience. (Research tells us that doctors have higher levels of resilience than comparable employed peers.) Paradoxically, high levels of resilience are one attribute that enables individuals to keep working in untenable circumstances. But too often, our systems and governments have relied on work force resilience as a kind of de facto strategic plan – in lieu of an actual plan to deal with the suffering, burnout, and collapse of the work force itself.
That important backstory means health care workers are often wildly, appropriately triggered when their organizations talk to them about resilience, mindfulness or wellness – because it is so often presented in terms that are genuinely offensive. (“House collapsing? Try this glue stick; Furnace broken? Get a parka.”) I once jokingly coined the term “muffin rage” to describe the overwhelming anger I experienced when “resident appreciation day” in my 100-plus-hour-a-week work environment consisted of the institution offering a table of free baking. I was surprised when the term gained international traction. In retrospect, I think it’s because it captures something we often feel that is rarely articulated. Muffins don’t help you face a patient when you have to be the one to tell them their procedure has been cancelled for a fifth time. They don’t treat depression, anxiety or suicidal ideation – all common and especially stigmatized in the medical profession. And they don’t address the pervasive political, leadership and structural failures that have become intrinsic and seemingly permanent features of how our health care system operates.
But here’s something I know for sure. The thing more likely to kill us than muffin rage is what lies just beyond it. Rage can at least drive change – but in the absence of evidence that change is possible, rage is metabolized into bitterness, then complacency. Soon we are confident there is nothing more we can do to help anybody, including ourselves. That conviction becomes our only script. After a while it is the singular story we tell about our work, and we forget what we came here to do in the first place.
We’ve lost a coherent narrative – even a sense of what it is we aspire to provide for Canadians. The constant stream of ‘bad’ stories about health care have become almost meaningless, the standard headlines so devoid of charge they are like empty husks. Is a crisis really a crisis if we never respond as if it is?
Two years ago, a doctor named Lauren Miller said something that brought this idea into sharp focus. A junior resident at the time, she approached me at a conference and asked – a little shyly – if I thought it was possible that burnout and brokenness had become so accepted as the “cost of admission” into medicine that the fundamental human experience of bearing witness to suffering was now permanently enmeshed with depression, despair, and despondency. Weeks after that encounter, I found myself replaying her words, and sitting with the natural next question. Was our contemporary emphasis on headlines and stories about that “burnout and brokenness” permanently shaping the kinds of stories students were telling themselves during their formative years? The problem was becoming an example of a classic Buddhist principle. As more than one wise teacher of mindfulness has taught me over the years: what we practise, we become.
One of the things my students do during the three-week program is tell stories – but in a very particular way. A substantial part of our time is dedicated to conversations using both deep listening and structured prompts. Embedded in hours of didactic, evidence-informed teaching, the students share stories with each other in pairs, building the skill of deep listening without interrupting or interpreting, offering each other their unconditional presence.
When, in the past four years, were you part of something that went very wrong? When were you present with great suffering? When did you face extreme uncertainty?
These conversations aren’t meant to generate cookie-cutter LinkedIn-style insights – they are intended to unearth messy, unfinished, gritty, intense and largely unprocessed moments from the students’ careers thus far. Their stories are a collection of dark, dramatic moments of bearing witness – stillborn babies, rare and disfiguring diseases, surgeries with catastrophic outcomes. And there are also many intimate, unfinished and haunting stories that continue to loom large in students’ minds and hearts. In those particular tales, the student is often the imagined culprit or feckless bystander at the centre of the action – blurting out inaccurate or awkward words at the wrong moment, missing a significant lab value or sign they didn’t understand at the time, standing frozen in the face of grief or loss. And there is almost always a universal realization at the end of these exercises, a hushed, astonished, sometimes tearful, wholly stunned version of this utterance: I thought I was the only one here who felt like this. I was sure it was just me.
While we move tenderly through those stories of pain, failure and agony, we have a second destination as well: stories of meaning and hope. Emphasizing meaning in work has been shown to be a powerful protective factor against burnout – not a replacement for the system and organizational changes we need, but rather a distinct element that promotes our well-being and fulfilment. So now we sit intentionally with lighter questions, ones that spark a very different set of emotional and physical responses.
When in the past four years did you experience a moment that was deeply meaningful to you? When did you make a difference to someone, even if in a very small way? When did you experience a moment of profound connection? When did a clinical encounter make you grateful?
These are stories of shared humanity: translating a doctor’s words into another language for a frightened patient, holding a hand or making a scared child laugh, experiencing an unexpected moment of intense connection. The students share the pride of feeling useful, giving comfort, alleviating a symptom or a burden. One student described these moments as an exchange of “life-giving energy” – but she correctly observed that this could only happen when lines for that exchange are open on both sides. I witness that same kind of open exchange between the students when they relive these profound experiences. In those moments, medicine isn’t a pit. It’s a portal to something tender and sacred – easy to miss if no one has ever shown you the doorway and told you where it can lead.
If the special focus on the positive experiences of practice sounds like feel-good psychobabble, the research tells us it is much, much more. Psychologist J. Bryan Sexton at Duke University has demonstrated the clear benefits of teaching health care workers to dwell on the good things in their work. Without training our attention on the positive, it will always be dwarfed by our automatic recall of the bad. This isn’t because of some inherent deficiency in us as health care workers. All minds come hard-wired with a negativity bias – a predisposition to see and recall the negative much more easily than the positive, a setting best understood from an evolutionary perspective. In high-stakes environments where negative outcomes are dramatic and highly consequential, the good dies in the long, suffocating shadow of the bad. That’s why we have to bring the good out into the light.
The bone-deep misery of Dr. Robby on The Pitt isn’t aspirational in a professional sense, but maybe the belief that it is inevitable has been normalized.Warrick Page/The Associated Press
It’s also important to point out that this work isn’t a substitute for core medical knowledge and clinical skills. It doesn’t replace time spent building those foundations – and that’s precisely why it isn’t offered until students have enough clinical experience to understand its relevance to that base. One of the course’s ultimate goals is to improve awareness of how we think as doctors – so we can practise with more clarity and compassion, as well as insight into ourselves. Just as importantly, at a time when even a mild increase in health care worker attrition due to burnout is an added existential threat to our system, my students describe the class as life-changing, life-affirming and transformative. Critically, it reminds them not only of what is still within their ability to control, but of what is still deeply, deeply meaningful about practising medicine.
Many students share insights that stick with me, but here’s one I’ll never forget. On the last day of this year’s class, a student said the most unexpected thing he’d been given by the course was permission to be outwardly happy. He reflected that there is a social risk to being perceived as content or peaceful in medicine when the system – and our world – is in crisis. (“What is that idiot doing, smiling and laughing? He must be too stupid to realize how bad things are.”) The bone-deep misery of Dr. Robby on The Pitt isn’t aspirational in a professional sense, but maybe the belief that it is inevitable has been normalized. And that cannot be the only way we are taught to experience a life in medicine.
It’s hard saying goodbye to my students. In the days before the course finishes, we all have a little separation anxiety, wanting to preserve the community we’ve built – the connections, the shared jokes, the insights. The students have acquired new skills, and they’ve largely embraced the importance of choosing a balance of stories to tell themselves and others about their journey through medicine.
But while good stories about medicine are medicine, stories are also not enough. And here’s the bitter parallel reality – health care in Canada has a story problem. We’ve lost a coherent narrative – even a sense of what it is we aspire to provide for Canadians. The constant stream of “bad” stories about health care have become almost meaningless, the standard headlines so devoid of charge they are like empty husks. Is a crisis really a crisis if we never respond as if it is? Is an emergency room even an “emergency room” if people die there while they wait for hours? Is a situation really “unacceptable” to us if year after year we take no effective steps to address it, suggesting that we have, in fact, accepted it?
Here’s what I think about health care in Canada in 2026: a truly new story would have to start with the hardest question of all. That question is eerily similar to the question people ask about the climate crisis. Are we, as a country, really prepared to do whatever it takes to change? Are we prepared to ask uncomfortable questions, sit with uncomfortable answers, and try to understand what assumptions, beliefs and realities are the most limiting to us? That’s where real change starts. But that kind of conversation requires a kind of radical, painful, searing honesty that we don’t hear often enough from our politicians, professional organizations or leaders – and it is a conversation more akin to negotiating for peace than negotiating with labour. If we truly want things to change, we will all have to take new risks and give something up. But the hard reality is this: there are ways in which all invested groups – save for our suffering patients – are making some elements of the problem worse. And I don’t know how much worse things have to get before we are ready to say that out loud.
So this is my message to all those students donning the white coats, and it applies to anyone joining the helping professions in 2026. These are hard times, but not hopeless times, and one of the things you can do to help yourself personally is choose the best stories you can to get you through the years ahead. It’s an unsatisfying message for an overwhelming moment – nothing AI would ever tell a speaker to say for inspiration or applause. But every writer knows that if you want to change an ending, you have to change the story. I’m a doctor and a writer. Maybe that’s why I still believe a different ending is possible.