Honoring the Hype

Someone asked me what to do if your career in medicine feels boring, you feel like you're only doing it because it's the right thing to do, and working part-time or choosing a specialty with good hours feels like hedonism. This is what I wrote in response.

If you think your career as a physician is boring, you need to take a long hard look at what you’re doing. The longer I reflect on what it means to be a physician, the more I understand it to be a calling. It’s truly a vocation, and I apply that word because I don’t think that it should be done by people who don’t feel compelled to don that yoke.

I’m not saying you need to be hyped for your career 24/7, or even every year of your life. But you’ve gotta have a little hype – that hype allows us to pick ourselves up on days it’s really tough, it makes us honor the privilege and responsibility of having lives in our hands, and it, hopefully, compels us to do better for our patients with a measure of humility.

There isn’t a heavenly ledger that catalogues your gives and your takes from this world. We are all giving and taking – in fact each act of giving is an act of taking in some way, too, and vice versa. That’s what being a member of this human race is. You shared your bread with your sister and you gained generosity. You taught your brother and you gained a student. Your mother gave you life and you gave her motherhood.

To harp on a similar concept, there is no purely selfless motivation for pursuing medicine. Guilt will only take you so far before it corrodes.

I know that guilt makes up some of the fuel that powers my own motivation, but there are many other things too. Ambition, drive. And a deep, insatiable love and curiosity about humanity that means I care deeply about people, and also find a great joy in connecting with them. Do you see how that has some selfishness in it? I really want to help people, and also this way of helping people is one I find deeply satisfying and stimulating. It incites passion and drive in me. All of these things are roiled up together into the reason I’ve stayed on this medicine track.

(And you know what? I’ve checked in with myself every step of the way, to make sure I still wanted to be on that track. Before starting med school, I gave myself permission to quit if I started to hate it, if I didn’t think it was right for me. And so I took that seriously, and feel ever more confident on this path. I’ll continue checking in as my life moves forward.)

This is why I don’t think there’s a purely selfless reason to pursue medicine, and I am suspicious of people that claim they have one.

Now the reason I’m talking about this is because it matters for patients. I’ve been saying this for a long time now, but please believe that I really mean it: a doctor that doesn’t have some hype, that doesn’t feel connected to their career and therefore doesn’t connect to patients – in other words, a doctor that’s burnt-out – that doctor isn’t a good doctor. S/he might show up to work every day, might diagnose and prescribe as indicated by the clinical guidelines, might dot all the i’s and cross all the t’s. But the more and more studies we do, the more we realize how essential the relational component of medicine is. Having a doctor that’s well improves patient health. It’s just a fact.

So if working part-time is what it takes to maintain your hype, then please work part-time. If specializing instead of entering primary care is what it takes to maintain your hype, then please specialize. Etc! When you see a patient, ask yourself if you’re there in that room with that patient, fully mindfully present, human-to-human; if you’re not, figure out what you need to do to make it happen.

I’m not saying you need to quit if you’re not feeling the hype 24/7. But I am saying that you should take care of yourself, and not make a decision based on guilt, and really try to know yourself in this career. Nosce te ipsum; know thyself.

I sincerely hope that helps.

Best,
Monica