We've entered that stage of life: begun to lose parents, seen peers stricken with cancer as the youthful patina of invincibility fades, and started to give up pastimes we thought we'd never stop enjoying.
As a result, the typical conversation with a non-medical friend my age tends to follow a template.
Dissatisfaction is expressed regarding a new boss, the latest cut to the old benefits package, or the insurmountable sum that will be needed for retirement.
Complaints lifted from Annie Hall might even weave their way into the conversation.
Friend: I feel empty [working at my hedge fund/helping clients sell widgets to the unwitting/making a tastier taco sauce]. It's not like your work, where you are saving lives.
When I was a young Turk starting out in emergency medicine, I'm ashamed to admit that I smugly bought into this societally-perpetuated delusion.
I felt tired as anything and unable to put more than two coherent sentences together, but viewed through the eyes of my admiring peers, I was nothing short of a hero.
The hospital controlled my schedule, undermined my health and dictated what social engagements I could attend. So I accepted admiration from peers as a substitute for presence or agency in my own life.
It would be almost a decade before I realized that this was a story we physicians sell ourselves to continue working unsustainable hours in an unforgiving environment. The prompt was an amusing article in a professional society newsletter by Vanderbilt's Dr. Corey Slovis.
It was an article about the simulated clinical scenarios in the Oral Board Exam for emergency medicine. The cases were like the sexiest storylines from the medical TV drama of the day, and had little in common with 90% of our actual practice.
Rather than managing multiple trauma patients simultaneously or a hypotensive patient in rapid atrial fibrillation, he pleaded, wouldn't it make more sense to have cases that better resembled the reality of what we saw daily in the emergency department?
Cases where despite sound clinical rationale, the cause of discomfort remained unknown despite an extensive workup. Where the best we could offer the patient was, "I have no idea what is causing your pain, I'm going to prescribe you a couple of days' worth of pills to lessen your discomfort, please return if you feel worse..."
The idea that what we do best in medicine is learn to live with uncertainty and mitigate risk rang true recently while reading a refreshing post by Physician on Fire, titled The Unspoken Risks of NOT Retiring Early.
Among other points, PoF emphasized that life can be short, but it brought up an unrelated facet of being that I wanted to explore further: Because physicians are high on the pyramid of societal respect, we don't spend a lot of time struggling to define what gives us meaning and purpose.
It is assumed that being a doctor inherently provides meaning and purpose enough to sustain us over a lifetime. While that's may be the case for a minority of my colleagues, the vast majority of physicians use the status imbued by the white coat to skip the struggle entirely.
I'd consider one of our defining experiences as human beings to be the struggle we undertake to build a life. For those of us fortunate enough to have jobs that fulfill the basics in Maslow's heirarchy of needs, we have the luxury to focus on the highest levels. A refresher:
- Physiologic needs
- Safety
- Love and belonging
- Esteem (based on both respect from others and your own self-assessment)
- Self-actualization (reaching your full potential)
The physician job largely ensures that items 1 and 2 are covered. Item 3 varies by the individual. Item 4 is half covered by the profession. This leaves the development of an internal scorecard (item 4) and the space to both define and then pursue your full potential (item 5) as tasks that need attention.
The problem is that too many physicians omit the final two steps completely. They substitute respect from others for self-respect. Having dealt with struggle through their training and education, they avoid the additional struggle of defining their values and purpose outside of their career.
We all entered medicine wanting to help people. We gave up a significant portion of our youth to pursue it. Let's not mistake our profession for our identity by avoiding the process of defining what matters at the individual level.
Accepting societal definitions in an uncritical manner spares us from the struggle that characterizes the human condition which encompasses both problematic and joyful facets.
Our value as flawed humans may well reside in how we grapple with life's big questions of purpose, meaning and service beyond our own self-interests. Let's not grow so complacent by virtue of having become physicians that we lead unexamined lives.