Why I Practice

When I was still married and when I spoke with medical students or talked to people who asked me why I became a doctor, I used to say, "It's like marriage: the reasons we stay married are not the same as the reasons we got married in the first place." And, I would add, "Likewise, the reasons doctors practice medicine are not the same as the reasons we went to medical school." The remark sounded wry and self-knowing.

Many people would like to hear that I went to medical school out of a selfless desire to heal. Or because I was the smartest guy in college, and I wanted to put that to use to help people. Or at least, that is what I believe most people would like every doctor to say. I am unsure how different I am from other doctors, but those are not the reasons I went to medical school. I half realized even then that I went to medical school out of a lack of imagination.

After college, for various reasons, I was adrift. I had a degree in English Literature — that is a whole 'nother story — and I knew I needed to make a living somehow. So I tried cast about some ideas. And I made lists.

I came up with vague notions about what I did and didn't want in a career. I can articulate them here in a way I was incapable of then. Among other things, I didn't want to have to market myself; I wanted a safe career. I do not feel sufficiently organized or self-driven to "climb the ladder." Upwards, it seems, is not the direction I pushed myself. I wanted, instead, for the path to be laid out such that, having completed whatever course of study I chose finally to pursue, there would automatically be a job waiting. Moreover, I wanted this this job to be vaguely synonymous with a skill and that did not require "advertisement." In other words, I didn't have to constantly justify what I did for living. Certainly there are deep-rooted insecurities related to all this.

It is also true, of course, that I wanted to do something somewhat scientific but not at a bench top. And I wanted to help people. Mostly, however, my list was as above.

Medicine seemed to fit my criteria, and at the time I couldn't think of anything else — I couldn't imagine anything else — that fit my criteria. So I applied to medical school out of lack of imagination. (My lack of imagination did not end there. I imagined shockingly little, for instance, about the money and politics involved, let alone what it might mean to have patients who would look to me to fix their illnesses.) Nonetheless, I applied to medical school and was accepted. Then I graduated, and then I went to residency. And now I practice.

The list I've written above, the list of what I wanted in a career, is not exhaustive. I also wanted to do something creative. And I wanted to work in a nonhierarchical, non-competitive atmosphere. And I wanted to grow skills, grow rooted, grow as a person, and grow wisdom.

In retrospect, I know that if I had put as much time and effort into anything else, into my piano practice or into looking into writing or photography or teaching or into other aspects of science, I would have found other choices. It is not that a career in any of those fields, or in a field I have not mentioned, would have fit my criteria better. It's simply that they would probably have fit them just as well as what I chose.

Within a few years, I came to see that the reasons I chose medicine as a career are not the reasons I still practice it. Mostly I continue, because there is nothing else I can do. I am not trained to do anything else, nothing I can make a living at, nothing I can do with half the proficiency. This is especially true, now that practicing medicine now comes so easily, too easily in some sense, frightfully easily.

Now that I am divorced — "medical marriages," a term I despise, have an abominably dismal rate of success — my medicine as marriage metaphor has come to sound ridiculous to my ears. Similarly my career in medicine wandered from the path. Medicine became, for a time, a job, and my spirit succumbed to some of its unpleasant aspects. I let my ego get sucked into leadership positions, medical directorships, "practice improvement" committees, and so on.

I do still enjoy the practice of medicine, though it seems curious that I am still discovering the joys and still discovering why I am here. I enjoy the stories of my patients. I enjoy the complex problem solving. I enjoy the small amount of science I can dabble in. I enjoy many of my colleagues: the aids, nurses, and other doctors where I work. And I enjoy helping people.