Is medicine the “holy grail”(finding satisfaction in practice)?
Every day I read many letters and posts from undergraduate students who view a career in medicine as the ultimate prize for academic achievement. While this view may keep many pre-med students on the road to high academic achievement, a more realistic view of this profession and it’s practice is a better choice for keeping a strong perspective. It’s very admirable to wish to enter medicine to “help people”. In truth it is also admirable to enter medicine because you want to be well-compensated for the work that you perform but monetary compensation will not keep you bounding out of your front door every morning as you begin a 16-hour day with many challenges. Medicine is very much like the publishing of a daily newspaper in that you have to work through the hundreds of daily challenges and get them right while loving what you do. When I say loving, I can also add that along with that love there needs to be a bit of compulsion albeit healthy that has to be in your personality. In short to be an excellent physician, it’s about always being, to quote Larry King, “100 per cent when the light goes on” with the light on practically every minute of the day.
Why good medicine may be difficult for even the most dedicated
It’s not just the surgical specialties where one has to “get it right” or life-changing consequences can happen for both the surgeon and the patient. Non-surgical specialties are far more difficult to practice at the highest level than most surgical specialties with the greatest hurdle for the primary care physician, being the time constraints, though operating room time has always been expensive too and the knowledge acquisition challenges that would frighten many other professionals. A physician simply has to be adept at the mastery of many hundreds of pages of information that will prove crucial to practice on a daily basis, like no other profession. It’s the time between seeing patients that becomes a snippet of both “down time” and “breathing” time which keeps everything moving. Additionally, a good physician has to become adept in communicating with patients and staff in order to achieve the best outcome for their patients. It’s a narrow fence to walk on a daily basis with the unknown which eventually becomes a constant companion.
If the pursuit of a career in medicine is causing an applicant to attempt to significantly change their personality or ethical system, then medicine becomes a symptom of a problem that will make the practice of medicine very difficult. Medicine is not for every person either from an academic/scholarship standpoint or from a personality standpoint. With the length of the day and the complexity of excellent job performance, a candidate doesn’t have the time or the energy to keep up and “act” in order to fulfill some perceived “fitness” for medicine. My medical practice is as much an extension of who I am as a person rather than the product of any training that I received in medical school or residency. It didn’t make a difference that I entered surgery as my personality doesn’t allow me to act like an “entitled jerk”. There are too many moments when I find myself thanking my maker for getting through the day and not losing my perspective or awe of the majesty of every human being from that elderly veteran to a newborn with multiple congenital anomalies. In short, your patient’s and your community will demand that you keep a solid balance between humility and hubris.
When one starts to complain about “lack of a life” or having other “passions” outside of medicine before one enters the field, one should probably question whether medicine is the sound or compatible career path. If you find that you just love doing procedures and duties of the physician but you are constantly worried about your life outside of the practice (“I want to be home at 5pm every night”), you may want to consider pursuing the profession of physician assistant (less training time and less responsibility) rather than making a minimum 7-year commitment to medical training in addition to the life-long learning at a high level. If you can’t learn to find balance between medicine and your outside life within the boundaries of training, you won’t find that balance once your training is completed. By selecting the profession of physician assistant, the shorter training period coupled with a bit less responsibility might be an ideal fit for someone who has multiple interests outside of medicine.
I found quite rapidly that I needed to set more of a standard for study and scholarship outside of residency than inside. For me, combining teaching with practice was an ideal situation as my teaching forces me to keep up with my literature reading and the latest clinical practices for my specialty. For some of my colleagues, the work of practicing evidence-based medicine is a chore that they seem to avoid at all costs which can be to their detriment. There is a compulsion that tends to keep me focused on getting my work and reading accomplished each week. I generally find that I have plenty of time to pursue other interests outside of medicine within reason. As the daughter of a physician and coming from a family that boasts 10 physicians between aunts and cousins in every specialty, I can say that none of us suffered because our parents didn’t make every recital, soccer game or play. We learned to be self-sufficient, almost to an extreme point and we learned that the love and support of our parents was always present even if they couldn’t be at an event physically.
Well, medical practice and medicine isn’t a sacrifice for me. It’s always a wonderful opportunity to test myself both mentally and physically. I have found that I have some innate qualities that allow me more ease with practice, such as not needing more than 4 hours of sleep, sleeping lightly – never missed a page, and having a generally upbeat disposition with an ease of communication. I simply adapt as best as possible to the situation at hand without much angst and worry. If I don’t believe I will enjoy working on a project, I don’t agree to do the project in the first place. I also have adapted to the thousands of changes that have become a part medical practice since I entered the profession nearly 10 years ago. For folks who have a difficult time adapting to change, medicine will be an extreme challenge. One cannot expect that medical school will teach everything needed for a modern practice nor does the medical school attended (as long as it is accredited and in the USA for practice in this country) matter much once you are done with that portion of your training. The habits learned long before medical school, such as, consistent and strong scholarship/study skills will make more of a difference in your practice as opposed to the school that you attended.