Cynicism vs Clear-Eyed Realism: How to Keep Showing Up When Healthcare Keeps Breaking Down

Let's start with what we're NOT going to do: We're not going to gaslight ourselves into thinking that everything in healthcare is fine. We're not going to use coaching tools to convince ourselves that systemic failures are just "mindset problems."

Because here's the reality in early October 2025: Healthcare is objectively a disaster right now.

The State of Things (Without Sugar-Coating)

Government officials are actively undermining established vaccine science. The President recently held a bizarre press conference connecting Tylenol to autism. Insurance reimbursements continue declining while expectations increase. Staffing is skeletal at best.

If you're a physician right now, you're being asked to do more with less while navigating an unprecedented level of medical misinformation coming from the highest levels of government.

You have every reason to feel cynical.

But cynicism, while understandable, is also a trap.

Why Cynicism Makes Sense (But Doesn't Help)

Cynicism is a protective mechanism. Your brain thinks: "If I expect nothing good, I can't be disappointed or hurt anymore."

It's a completely normal response to repeated disappointments. Especially for those of us who lean toward people-pleasing, cynicism feels like an extra layer of failure on top of our inability to make everyone happy.

But here's the problem: Cynicism doesn't actually protect you from pain. It just makes you passive.

When you're stuck in cynicism, you:

• Assume everything will stay bad
• Stop advocating for change
• Don't protect yourself with boundaries
• Infect everyone around you with that heavy energy

Think about that bright-eyed new medical assistant who starts out optimistic and positive. Watch how quickly the cynical culture turns them hard and bitter. That's the contagion effect.

Cynicism makes sense. But it doesn't help you survive.

What Clear-Eyed Realism Looks Like Instead

Clear-eyed realism doesn't stick its head in the sand. It acknowledges reality without drowning in helplessness.

Cynicism says: "The system is broken and there's nothing I can do about it. Nothing matters."

Clear-eyed realism says: "The system is broken AND I choose how I respond. I choose how I show up. I choose what I do and don't do."

Let me give you concrete examples of what this looks like in practice.

Medical Misinformation

The reality: Patients are confused or convinced by misinformation from sources they trust (including government officials).

Cynicism's response: "Nobody listens anyway. Why bother?"

Clear-eyed realism's response: "I can't undo all misinformation. I will choose when to engage in these conversations and when to set boundaries. I will be a trusted source for patients genuinely asking questions, but I won't exhaust myself arguing with hardened positions."

Staffing Shortages

The reality: You're expected to maintain full productivity without adequate support staff.

Cynicism's response: "This is impossible. I guess I'll just keep drowning."

Clear-eyed realism's response: "When I don't have a medical assistant, I physically cannot do everything I'm being asked to do in the time allotted. I will prioritize patient safety and set boundaries around what's actually possible. Something has to give, and it can't be safety."

The Impossible Wellness Visit

Here's a scenario that happens constantly in primary care: A patient is scheduled for a 15-minute wellness exam. You're supposed to do a Pap smear, update vaccines, review preventive care, and address health maintenance.

But the patient bursts into tears about chest pain and shortness of breath.

Are you going to proceed with the pelvic exam? Of course not. You're going to address what's actually happening.

This is clear-eyed realism. You meet the situation where it is. You do what's appropriate. You drop the expectation that you should be able to do everything.

Deciding Where Your Energy Goes

You cannot fight every fire. You cannot solve every problem. You cannot meet every metric when you're systematically under-resourced.

You must decide where your limited energy goes.

This means:

• Choosing when to engage with vaccine-hesitant patients and when to state your position and move on
• Setting boundaries with administration about unrealistic expectations
• Accepting that some preventive care boxes won't get checked when you're short-staffed
• Letting go of perfectionist ideals about how visits "should" go

None of this means you're compromising patient safety. It means you're acknowledging resource constraints and making strategic decisions about how to practice sustainable medicine.

What About Optimism?

You might be thinking: "So should I just be optimistic instead?"

No. That's not realistic either.

There ARE very difficult things happening in healthcare, in the world, and possibly in your personal life. Pretending otherwise isn't helpful.

But you also don't have to choose between toxic positivity and drowning in cynicism.

You can acknowledge that things are hard while still maintaining agency over your choices.

The Work You Need to Do

If you find yourself wallowing in cynicism, doom-scrolling, hating everyone and everything (and yes, I go there too - I'm human), you need to ask yourself:

• Is this who I want to be?
• Is this how I want to show up?
• Is this how I want to meet this moment?

If the answer is no, then you need to figure out what you WILL do instead.

This might mean:

• Practicing boundaries even though it's uncomfortable
• Allowing yourself to disappoint people who expect more than you can give
• Doing "less" than you're technically capable of because you don't have adequate resources
• Getting support from a coach or therapist to navigate these impossible circumstances

You're Not Broken

If you're struggling right now, it's not because you're inadequate or inefficient. It's because you're being asked to do impossible things in a fundamentally broken system.

The system is failing you. Not the other way around.

Your job is to decide: How will I take care of myself while navigating this reality?

Because if you don't, eventually something will take you out. And we can't afford to lose physicians who still have their humanity intact.

Your Next Steps

Things are hard. They're going to stay hard for a while. But you have more control than cynicism wants you to believe.

Ready to work through what clear-eyed realism looks like for your specific situation? Listen to the full episode here where I walk through these concepts in depth, including how to set boundaries without guilt.

Want weekly messages that acknowledge reality while helping you stay in the fight? Join my email list for physician-specific support that doesn't gaslight you into thinking systemic problems are mindset issues.

You can also reach me directly at [email protected] - I'd love to hear from you.

Because staying in medicine right now requires both clear eyes about what's broken and fierce boundaries around what you'll sacrifice to keep showing up.

Dr. Megan Melo is a family physician and certified life coach who helps women physicians navigate impossible circumstances without losing themselves in the process. Learn more at www.healthierforgood.com.