The good-reason-to-be-a-doctor police

From Insider’s Pre-Med Guidebook: Advice from admissions faculty at America’s top medical schools:

Every year, hundreds of thousands of students pursue premedical studies at four-year universities across the United States and the world, and they, too, want to become physicians for a myriad of reasons. Many will find their reasons to be mature and well-reasoned. These students will find the motivation and strength to succeed as pre-med students, medical students, and physicians, and they will live happy and productive lives. Others will pursue medicine for reasons that are immature, underdeveloped, or untested. For these students, there are two major possibilities: they will struggle through their pre-medical studies and drop out, or they will end up dissatisfied with their life-long careers as doctors.

Before you pursue medicine as a career, you must be sure medicine is a good fit for you. If your motivations are poor or false, you will not have the drive to succeed during the long and difficult road ahead. You will lose time, money, and the opportunity to pursue whatever your passion truly is. If your motivations are genuine and well-developed, you will find this path to be easier and infinitely more rewarding. Not only that, but your passion will shine through the activities you pursue. Medicine is a pursuit that is simply too long, too difficult, too costly, and too important to pursue for the wrong reasons.

I would like to call bullshit on these bland truisms.

Someone show me some data.

I think there are plenty of folks who choose medicine for the “right” reasons and then get burned and churned through the medical training gauntlet. It’s hard, and the difficulty varies for different people for different reasons. It’s a specious argument that unhappiness with a medical career stems from flawed motivation as opposed to, say, a toxic training paradigm or a flawed healthcare system.

And, I think there are lots of folks who choose medicine because it’s a challenging well-compensated job where you generally have a meaningful positive impact on other humans on a daily basis.

Your pure soul can be exclusively motivated by humanistic altruism but actually have zero idea what it’s actually like to be a doctor day in and day out. Because shadowing isn’t the same as doing it for years.

You can be passionate about “medicine as a career” for all the “right” reasons even though the “career” you’ve chosen is actually a broad umbrella under which there lies a huge variety of professions from diagnostic radiology to general surgery to psychiatry?

I’ve never been convinced by the idea that good successful doctors are mostly a bunch of 18-year-olds who have a singular understanding of their lifelong “passion” let alone a meaningful understanding of medicine.

I’ve known wonderful failed pre-meds who would’ve made excellent physicians but didn’t make it through the gauntlet, and I’ve met plenty of self-satisfied doctors who got through but probably shouldn’t have.

Show me some data that the process selects for the right reasons and not just the right boxes checked.


Slim pickings high up on the ladder

From Nobel laureate economist Richard Thaler’s Misbehaving: The Making of Behavioral Economics:

A competitive labor market does do a pretty good job of channeling people into jobs that suit them. But ironically, this logic may become less compelling as we move up the managerial ladder. All economists are at least pretty good at economics, but many who are chosen to be department chair fail miserably at that job. This is the famous Peter Principle: people keep getting promoted until they reach their level of incompetence.

I wrote an article called Academic Medicine and the Peter Principle back in 2019, and the mismatch between merit for admission, merit for promotion, and skill at a given position explains so much about so many rudderless institutions.

Feynman’s Wish

As we near the end of the residency interview season, a choice quotation from “Surely You’re Joking, Mr. Feynman!”: Adventures of a Curious Character:

So I have just one wish for you—the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity. May you have that freedom.

This is Going to Hurt

From the original UK version of Adam Kay’s This is Going to Hurt: Secret Diaries of a Medical Resident:

Asked to review a patient in labour ward triage and repeat a PV as the midwife is uncertain of her findings. Her findings were of cephalic presentation with cervix 1 cm dilated. My findings are of breech presentation, cervix 6 cm dilated. I explain to mum that baby is bottom-down and the safest thing to do is to deliver by caesarean section. I don’t explain to mum which part of the baby the midwife has just stuck her finger in to 1 cm dilatation.

Good medical humor is rare.

Carving out a Creative Routine

From Keep Going: 10 Ways to Stay Creative in Good Times and Bad by Austin Kleon:

In his book Daily Rituals, Mason Currey catalogs the daily routines of 161 creative individuals: when they woke up, when they worked, what they ate, what they drank, how they procrastinated, and more. It’s a wild collage of human behavior. Reading about the habits of writers alone is like visiting a human zoo. Kafka scribbled into the night while his family slept. Plath wrote in the morning before her children woke up. Balzac slugged fifty cups of coffee a day. Goethe sniffed rotten apples. Steinbeck had to sharpen twelve pencils before starting his work.

It’s undeniably fun to read about the routines and rituals of creative people, but what becomes clear after a while is that there is no perfect, universal routine for creative work. “One’s daily routine is a highly idiosyncratic collection of compromises, neuroses, and superstitions,” Currey writes, “built up through trial and error and subject to a variety of external conditions.” You can’t just borrow your favorite artist’s daily routine and expect it to work for you. Everyone’s day is full of different obligations—jobs, families, social lives—and every creative person has a different temperament.

I’m not always sure that what I do here qualifies as creative work, but it’s so easy to fall into the jealousy trap looking at the routine of a full-time professional creative. It’s not hard to read a book like Cal Newport’s excellent Deep Work and think, yeah, that’s how you do it–if you’re an academic or knowledge worker.

I’m an academic physician working in a private practice. When you break it down transactionally, I trade time for money and then do a whole bunch of unpaid work on top that helps give my job extra meaning.

I’m a dad and a husband.

And that’s why it’s so much easier to have an amateur’s mindset instead of a professional’s: to do something because you like it or when the stars align.

But I’ve also found that I do better work and find more satisfaction in the work when it’s part of a routine (i.e. a modified professional mindset). My routine just isn’t one that involves long uninterrupted periods of deep work or a cabin in the woods.

I think the key is carving out a habit–or maybe a better word is a pattern–that allows you to fold in your avocations in a way that allows for regularity despite dominant competing obligations, recharges your battery, and still results in enough forward progress on your larger projects (if you have them) as to not be demoralizing (and it’s actually that last part that’s the hardest).