One Question to Rule them All

Medicine is hard, sacrifice is required, sleepless nights are always in stock. Awesome.

When you start medicine you know all this.

What you might not know is why you actually chose medicine. There’s so much information to unpack in the “how” that we forget about the “why”. 

Is it for the money? 

The respect? 

The security? 

The versatility? 

Do you do it simply because you couldn’t do anything else? 

Would a neighbour of your parents be impressed?

Would a crush?

Do you actually want to help other people or is that just a pleasant afterthought? 

You might already have a smart and almost original answer to why. If you are deeply satisfied with it, great! But ask it again anyway and then pause. 

Why did you choose medicine? 

The true answer (the one you would never actually say out loud) is probably dead and rolled up in a rug. It did not go live happily ever after on a farm with other truths. It’s probably buried somewhere in your backyard. Pick up a shovel and tell nobody what you uncover. But know it. This could spare you years of frustration. 

Whatever we chose to answer, we should never lose sight of an almost universal truth. Ego plays a role. Medicine has a robust legacy. In its shade, any useless self fades. Our personalities then become the medicine we practice, because that’s of higher value than most of our intrinsic qualities taken individually. Discipline, grit and determination are all great qualities to help us achieve a career in medicine, but we like to attach our names to “Dr.” specifically because people seem to care more about discipline, grit and determination when we do. 

But dig just a bit and you realise you are not truly and structurally what patients conjure up when they think of a doctor. 

You are incomplete, incompetent and a bit scared. People on the outside upload onto you a self-fulfilling prophecy. You slowly become it, and you slowly forget the nagging discomfort of the truth. But often (and deep down) you are not what patients hope you are. You are an imposter efficiently obscured behind a fog of suffering and hope. 

But so is everyone else. The truth about who you are is morphing ever so slightly each day. You get better and more equipped to deal with people and suffering. You learn the things that weren’t in the books. You become that self-fulfilling prophecy.

Once 20% of your career has passed, 80% of the skills you need most days will have been accumulated. You slowly spawn into existence the doctor patients hope they see. 

All this happens slow enough for us to ignore it. Through all this, we should keep our why in focus. You don’t want to look in the mirror one day and realise that being a good doctor is of little importance to you. If that ever happens, you will inhabit a very special little corner of hell and you won’t be able to step away from it. 

Young doctors generally make the mistake of thinking that they’ll suddenly be more satisfied once they reach a certain level of competence. You’ll be more confident and comfortable, sure, but competency doesn’t harbour the type of satisfaction you hope to achieve in life. For somebody who doesn’t know their why, competency only leads to frustration. You will be good at what you do and you will enjoy helping people, but once the dust settles, you’ll notice the echos of a nagging feeling that will invalidate most of it. Subtle and quiet, that feeling will dictate how you feel about your life. And if your whole life you’ve told yourself that being a good doctor is rewarding in and of itself when it isn’t, you’ll lose direction and become disillusioned.

If you don’t genuinely feel that saving lives is why you chose medicine, getting good at it will feel hollow. But if you accept that you went into medicine because, say, you wanted to be financially stable, getting good at it will actually help with that. 

There’s no good way to architect a structurally sound life, but you can do what’s in your power to minimise the chances of messing up. Start with “why”. Your why is the fuel that propels you forward. Search for it pragmatically, without the constraints of political correctness or philosophical musings. 

As long as you act honestly and morally, your patients will be better off being treated by a doctor who understands why they’re a doctor.