The Hidden Cost of Constant Readiness
Hypervigilance, which serves soldiers and clinicians in acute crisis, becomes a liability when it never switches off, quietly narrowing judgment and empathy until reduced capacity gets mistaken for professionalism. Dr. Bunin illustrates this through her own experience working sick in the ICU and sitting with a soldier who froze in combat, then argues that reflection, not endurance, is the professional competency that protects judgment and makes sustainable leadership possible.
The Hidden Cost of Constant Readiness A reflection on judgment, empathy, and leadership in healthcare
by Dr Jessica Bunin
I once put on a jacket I had not worn in weeks and found three cough drops in the pocket. I remembered instantly. The last time I wore that jacket in the ICU, I was sick. Not mildly. Sick enough that if I had been my own patient, I would have sent myself home. Instead, I rounded. I staffed critically ill patients. I made high-stakes decisions with a mask on and cough drops in my pocket, a quiet workaround for my own body.
That moment named something I had carried for years without examining it: the belief that professionalism means pushing through, and that patient care always outweighs self-care.
In medicine, we tell stories that reinforce this belief constantly. The resident who rounded with an IV in her arm. The surgeon who stepped out to vomit and stepped back in. We tell these stories with pride, as folklore, stripped of caution. Meanwhile, we quietly judge the colleague who calls out sick, using words like weak or soft. The message lands early and it lands hard. Real professionals do not stop.
I learned a version of this in the military first. Hypervigilance in combat is adaptive. It saves lives. But I carried that same hypervigilance into clinical medicine, into an ICU that mirrors combat in its unpredictability and its moral weight. Our physiology does not know the difference between battlefield and bedside. The nervous system is built for short bursts of threat, not indefinite activation. When we never down-regulate, judgment narrows, empathy dulls, and we call the result functioning.
I saw this most clearly during a deployment, sitting with a nineteen year old soldier who had frozen in his first firefight. I held that room for an hour without a word from him. I did the same thing, day after day, for every soldier who came through. I did not cry. Not once. The tears came later. They always did. Somewhere in the middle of that work, I noticed my own empathy responding from a distance. Not gone. Just muted, and working harder to get through.
That is the real cost of unexamined readiness. It does not announce itself. It just narrows everything, quietly, until we mistake reduced capacity for strength.
I saw the same pattern reflected back at me years later, when a resident sat in my office and told me, through tears, that he did not want to be an intensivist. I had mentored him for two years without ever asking what he actually wanted his life in medicine to look like. I had taught him how to succeed. I had never taught him how to choose. That gap was mine to own, and it changed how I mentor.
None of this is a call for less commitment. It is a call for reflection as a professional competency, not a luxury reserved for quieter moments. Reflection is the pause between experience and action where learning actually happens. Without it, we repeat patterns we do not understand. With it, we notice the cough drops in our pocket and ask what they represent before the cost compounds.
Healthcare does not need fewer committed professionals. It needs leaders willing to notice when commitment has slipped into self-harm, and willing to model the pause instead of the push. That work starts with a single honest question: when does readiness serve me, and when does it quietly begin to cost me?
Excerpted and adapted from Chapter 1 of Self-Awareness and Trust: Leading Healthcare Teams from the Inside Out, by Dr. Jessica Bunin.