Last Updated on November 27, 2023 by Laura Turner
Dear Aspiring Physicians:
I have been a long-time observer, educator, and supporter of physicians and those who aspire to that calling. As a physical therapist and educator in health care professions, I have spent over 20 years teaching communication skills to medical and pre-medical students and coaching students, residents, and fellows. From life with my wonderful husband as he traveled the path to becoming and living as a physician, and from my own experiences as a three-time cancer patient, I have a close and broad perspective on what I observe it takes to have well-being as a physician. Sometimes, those of us not swimming in the water may have valuable insights. As David Brooks describes, I feel like the “edge of the inside,” being the person who may see the wholeness of a situation and can appreciate the circumstance more clearly.
The work of a physician is incredibly challenging, and deciding to pursue this path requires genuine and thoughtful self-reflection. Without indulging in self-judgment, knowing oneself seems critical to being able to navigate and sustain a life in this calling. The bedrock of medicine is service to people, and there is powerful richness in that commitment. There is also a genuine and profound responsibility for the health of another that accompanies this choice. I have watched this weight descend on physicians as they train and see it become a part of their being that they carry with them until they let go of their work in retirement. There are moments of potent meaning that balance this charge, but it is always there. The requirement of putting the needs of others before your own is intrinsic to being a physician, which can be sapping if it is not compensated by fulfillment in this pursuit.
What fulfillment looks like is individual for each person, and an authentic life journey is made with that as the centerpiece. Most students express finding meaning in helping others. What that “help” looks like can be so variable and no less important, even if it is not in medicine. As a coach, I always ask, “What does a fulfilling life look like to you?” I emphasize, “Your whole life, not just your professional life”. Reflecting on what brings sincere meaning to life is an essential consideration for each of us in selecting any path. I have seen students who aspired to be someone they perceive as an inspiration. That “hero” may not be someone they can authentically become, yet looks like who they would like to be. It is like wearing clothing that is attractive on someone else and is a poor choice for themselves. What this role looks like on the outside differs from how it feels on the inside. No amount of money, awards, and status will provide fulfillment for a lifetime if there is not deep investment in your own true, enduring values. So, how would you know if being a physician is a fit for you? These are my thoughts.
Clearly, one must have an aptitude for learning the voluminous scientific content required to understand the complexities of the human body. However, so much more than the concrete answers to a multiple-choice test (i.e., MCAT), a physician needs to appreciate and embrace the ambiguity when multiple pieces of information conflict, yet still be able to make a decision. Curing patients may not be an option, and the acceptance of the limits of medicine is a challenging lesson to learn. A physician must crave learning because new information is being uncovered so rapidly, and those in this role must never feel like they have learned enough while being comfortable with that humility. This is a profession and a calling, not a job.
While patient autonomy has been steadily increasing through patient access to medical records and shared decision-making, the control and agency of physicians has been steadily decreasing. Time constraints, the requirements of tedious documentation, the threats of litigation, and a system that often falls short of providing for patients have created a different existence for physicians over the past decades. Once considered noble and trustworthy professionals, physicians are now responsible for proving their capability and building trust. Therefore, entering this field requires flexibility, acceptance, and a thoughtful manner of exercising agency in the face of the fluctuating practice of medicine. Even as a team member, the physician may be responsible for the outcome. Seeing yourself as part of a team and system, not always having the leadership role, may provide you with skills to navigate this course with more well-being instead of resentment.
Empathy is probably an overused word, but it is not an overused concept in healthcare. It is essential to have the compassion that patients yearn for in these most vulnerable moments when they must consult a physician. The previously mentioned responsibility of your work may try to squeeze the empathy out of you, as many studies have shown, over time in training. You must fervently hold onto the humanity in yourself if that fulfilling life is among your goals. In truth, if “helping people” is what you came for, you will never experience the genuine joy of that if you do not allow yourself to feel with your patients. It is a risk to let those feelings in because the sadness will be genuine when things do not go well. However, knowing you have communicated empathy and walked the path alongside your patient will let you know you have made a difference. The empathy must extend to your colleagues, other professionals, and staff. They are worthy of your respect, assuming good intentions and compassion when they are stressed.
The onset of COVID brought the commitment to medicine into stark relief for physicians and all health professionals. Not in recent years has the medical risk to the personal life of a physician been so present. Being asked and expected to serve patients in very dire circumstances with genuine fear for your health and family has brought absolute clarity to what it means to be a physician and healthcare professional. This obligation is a sacrifice that harkens back to the Hippocratic Oath, and you need to be sure that you can live up to that oath.
Given all these considerations, it is important to develop practices and habits that sustain you. Burnout is real, and self-care is imperative. Starting this journey with clear intentions about how you will care for yourself and create boundaries sets the tone for your work-life navigation. The essence of a good life depends upon that contemplation, and yet there will always be a fluctuating balance.
My words reflect my experience and the numerous conversations I have had over the years with physicians and those making the trip to and through medicine. The saddest thing to me has been those medical students and residents who have invested tremendous time, energy, money, and heartache into pursuing a physician’s life, only to find that it was not a fit for them and truly never held promise to give them fulfilling lives. Most have figured it out and found well-being in other paths. Learning about ourselves is a hard business and requires resilience to move forward in the face of some broken dreams. I have noticed it is always worth learning.
In rereading my words, it may sound as if I am discouraging the path to medicine. I am not. I like to think I am encouraging you to find your best life and understand better the choice you are making. The strength of this decision is clarified when you choose it again based on these considerations. This one precious life you have deserves to carry the best of you into what matters most to you. As you move on your journey toward a fulfilling life, I wish you the humility to reflect and explore what you know about yourself and your values. Being the person you want to be requires recognizing and grounding yourself in those deepest values, letting them guide you on that route. I hope many of you will see yourselves as a physician. If you do not, I hope you dare to listen to yourself and find the path of genuine fulfillment that is yours…you are worthy of well-being in your life.
Elizabeth Ross, DPT, MMSc, ACC
Associate Consulting Professor
Department of Orthopaedic Surgery
Duke University School of Medicine
Elizabeth Ross, DPT, MMSc, ACC is an Associate Consulting Professor in the Department of Orthopaedic Surgery at Duke University School of Medicine.