"Why do you want to be a doctor?", circa 2008

(ah, the beauty of shower thinking)

I remember this question was asked many times when I was applying for medical school in 2008. I had to explain it in essays, think of a unique way to tell my friends, and in a way reason to myself. In the end, it always came down to the patient, and being able to be there for someone in a way I couldn't in any other career.

Fortunately, someone (or some people) thought what I was saying was a good enough reason and I made it through, I'm almost a year into residency (wow). However, I'm looking back at that question and am wondering now if there's a slowly transforming mindset that is happening that is usurping the very reason why I went into medicine in the first place.

Before I start, I want to explain what happened today that triggered this train of thought. An older patient who I discharged today had a number of questions for me before she left. I was happy to answer some of them, but as time progressed I could sense myself getting more irritated at her persistence. I wanted to get back to finish the paperwork, and we were meeting to go over our patient list soon. In that instant though, I found myself wondering how I got to this point.

No matter what level of training, those of us in medicine face pressure on a daily basis. There's pressure to impress your residents or fellows senior to you, your staff, etc. You expect yourself to be able to answer all the questions they pose to you, and to do what ever task they ask you competently and mistake-free. It doesn't matter if you're told "it's ok" if you mess up, or don't know the answer, or that it's a learning environment, it gets to you. Secondly there are those smaller pressures, or annoyances that pull you in different directions. Tasks that need to get done. Did you write that progress note? Is that antibiotic dosage correct? Are you sure there's no interaction with these two meds? Is that abnormal lab value something you need to address? More items on that list.

Oh yeah, some sleep would be nice too. Are you going to get time for that on this call shift?

When you're not worried about how you're performing on a day-to-day basis, there's always a ladder to climb, or a rat race to finish. There's CaRMS in medical school, matching to the specialty you want. Evaluations, references, and elective experiences are all important. Then there's pursuing other fellowships afterwards. More references needed. Then there's securing an ideal job opportunity, or position. It's endless, and it's always in the back of your mind.

We also tailor the careers to the way we want. It's about our needs. What type of career will keep you mentally stimulated the most? What excites me the most? What lifestyle am I most comfortable with? How can I do more procedural skills? Where can I have the most autonomy?

Amidst all these arrows, sometimes the patient gets lost. Not literally. And in a way, not figuratively either. One of the biggest priorities of all is ensuring that you're not making this patient sicker or killing them. But what I think does get lost is the care.

We've all written that down in our essays. We wanted to go that extra mile for our patients. When we were just starting medical school or even before, we were resolute in believing the patient always comes first. We would all be that doctor who would sit by them longer than anyone else, be the one that really cares. Years later, am I still doing that? Am I still trying to do that? Do I even believe it's a legitimate part of my job description?

I'll be honest. There are days when I forget this conviction I had. I now think back to this lady who I was talking with today. All she had were a few questions for me. "Is it safe for me to continue exercising?" "Does arthritis affect my bones?" These aren't hard questions. I answered them... but in my mind, it wasn't so I could adequately educate her so she could better understand what illnesses she has, but so I could finish her discharge paperwork.

Remember your resolve, Josh.