A Stern, Sad, and Distrustful Man: Cynicism as Diagnosis in Healthcare

“A stern, sad, and distrustful man.”
—Nathaniel Hawthorne, Young Goodman Brown

Nathaniel Hawthorne’s short story Young Goodman Brown ends with this sharp epitaph. After venturing into the woods one night and witnessing what may or may not be a satanic gathering of his neighbors (beloved figures once seen as pure and faithful), Goodman Brown returns home emotionally hollowed out. He lives the rest of his life with suspicion and detachment, unable to reconcile the flaws he’s seen with the image of goodness he once held.

In medicine, many clinicians undergo their own version of Goodman Brown’s disillusionment. They enter healthcare with conviction and clarity of purpose…only to encounter moments that shake those foundations. They see good people make compromised decisions. They witness care denied, corners cut, injustices rationalized. Over time, the internal injury is not just to their energy or time, but to their sense of moral coherence. Cynicism, like contagion, starts to settle in.

The Moment of Disillusionment

Most clinicians can remember the moment they saw behind the curtain. It might be as dramatic as witnessing a preventable death or as quiet as realizing a beloved supervisor no longer sees patients as people. For some, disillusionment arrives slowly through chronic exposure to system flaws—visit quotas, billing pressures, documentation burdens. These moments form what has come to be described as moral injury: psychological distress that occurs when individuals are forced to act in ways that violate their core values (Dean et al., 2019).

Unlike burnout, which suggests emotional depletion, moral injury names something deeper: betrayal. It captures how many providers feel when caught between doing what’s right and doing what’s billable, or between meeting institutional targets and meeting a patient’s needs. It’s the ethical erosion that comes when one feels complicit in harm, not just fatigued by effort.

Medical students begin their training with some of the highest empathy scores of any group, but by the end of their education, studies show a consistent drop in empathy and a rise in cynicism (Spányik et al., 2025). The “hidden curriculum”—the values and behaviors implicitly taught by role models and institutions—often emphasizes detachment over connection, efficiency over reflection, and survival over meaning.

Cynicism as Contagion

What begins as moral injury can harden into detachment. And detachment, left unchecked, often metastasizes into cynicism. Cynicism is not a neutral defense mechanism. It’s a corrosive mindset; one that reinterprets every problem as proof of futility and every solution as naive. In healthcare settings, it spreads quickly. One 2023 study found that 34% of clinicians scored high on cynicism, and over half reported severe emotional exhaustion (Timbie et al., 2023). The primary drivers were system-based: time pressure, electronic health record overload, and lack of autonomy.

Cynicism is also linked to worse outcomes for patients. Studies have found it contributes to lower empathy, reduced patient satisfaction, higher medical error rates, and increased turnover (West et al., 2018). It affects clinical culture, too; normalizing disengagement, flattening moral nuance, and creating environments where colleagues learn to stop caring out loud.

When Goodman Brown loses faith in his wife, his minister, and his neighbors, he doesn’t confront them. He withdraws. He cannot bear the dissonance between their pious words and their hidden deeds. And, so, he stops seeing people clearly… living out his years “stern, sad, and distrustful.” In medicine, this same trajectory can play out not just at the individual level, but at scale.

The Risk of Losing Faith Entirely

Disillusionment is inevitable. Cynicism is not.

What differentiates the two is not what we see, but how we metabolize what we see. In other words, the challenge is not in having witnessed flaws. It’s in whether we come to believe that flaws are all that’s left. This is where the idea of practical hope matters. Practical hope is not the same as optimism. It is not believing everything will be fine. It is believing that improvement is still possible, even when we know the limits. It’s what allows people to engage in ethical action, without illusions, but also without despair.

One strategy that protects against cynicism is meaning-making. Studies show that clinicians who connect their work to a sense of purpose (even when conditions are hard) are more resilient and less likely to experience burnout (Shanafelt et al., 2009). Reflective practices, narrative medicine, and peer discussion groups have all been shown to preserve moral clarity by making space for grief, complexity, and context (Charon, 2001).

There are signs of system-wide disillusionment, too. Public trust in healthcare has declined precipitously in recent years, from 71.5% in 2020 to just over 40% by 2024 (Adams, 2024). Patients, like clinicians, are increasingly wary. They’re less likely to assume good intent, more likely to fear abandonment or dismissal. This mutual erosion of trust can feel like a stalemate, but it also opens the door for relational repair. Trust, like injury, is cumulative. It rebuilds slowly, moment by moment.

Why Navigation Isn’t Naïve

This is why the work of patient navigation matters so deeply. To the cynical eye, navigation may seem like surface-level triage—a warm handoff here, a coordinated appointment there. But it is far more. Navigation is restorative infrastructure in a system that has forgotten how to trust itself.

To explain a lab result patiently, to help someone prepare for a visit they’re dreading, to listen when they’re not sure what to ask—these are not small tasks. They are acts of relational repair. They signal that the system still has humans in it. And for the providers caught between obligation and overwhelm, navigation can serve as a mirror—reminding them what partnership looks like.

At Storyline, we know the system is flawed. But we refuse to act like the flaws are all that remain. We believe there is still room for dignity, still room for preparation, clarity, and conversation. What we do isn’t naïve. It’s a form of resistance.

When someone is ready to give up, we help them ask one more question. When someone doesn’t understand, we help them find the language. When a clinician is trying to care and a patient is trying to cope, we help them meet in the middle.

That’s not pretending the forest isn’t dark. It’s carrying a lantern anyway.

References

Adams, K. (2024). Trust in U.S. healthcare declines amid patient frustrations and clinician burnout. MedCity News. https://medcitynews.com

Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA, 286(15), 1897–1902. https://doi.org/10.1001/jama.286.15.1897

Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury not burnout. Fed Pract, 36(9), 400–402.

Shanafelt, T. D., West, C. P., Sloan, J. A., Novotny, P. J., Poland, G. A., Menaker, R., ... & Dyrbye, L. N. (2009). Career fit and burnout among academic faculty. Archives of Internal Medicine, 169(10), 990–995. https://doi.org/10.1001/archinternmed.2009.70

Spányik, A., Lewis, C., & Ferreira, J. (2025). Cynicism in medical education: Trajectories and protective factors. PLOS ONE, 20(4), e0276512. https://doi.org/10.1371/journal.pone.0276512

Timbie, J. W., Krause, T. M., & Friedberg, M. W. (2023). Health care professionals’ experiences with burnout, stress, and workload during the COVID-19 pandemic. JAMIA, 30(1), 45–54. https://doi.org/10.1093/jamia/ocac162

West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences, and solutions. Journal of Internal Medicine, 283(6), 516–529. https://doi.org/10.1111/joim.12752