Medicine is not just a job

But here's another thing: Many of those articles talk about medicine being a job that its practitioners don't want to do anymore. The problem with that is, medicine is not just a job.

Medicine is a belief system.

This is not to say that it ranks as highly as one's spiritual beliefs or life-philosophy system, but to reduce the practice of caring for patients to a job has no possible outcome other than to guarantee that it will be a job that people hate. The stakes are too high. Very early in medical school, a few of my professors (independent of each other) were very up-front about this: If anyone is here because you want to make a lot of money someday, leave now, for your own sake. Your money is somewhere else.

It's not necessarily a standardized belief system, but there are a few commonalities.

People who pursue medicine believe that life in general is worth something. Often, life needs maintenance, and people should receive help irrespective of the other details of their circumstances. A sick person's pain takes precedence over my fatigue; someone else's fever is more important than my sense of being overwhelmed, because at this moment I have the training to deal with those things, and the moment after this one, I get to leave the hospital and be with my family. Not everyone has that privilege.

If medicine is reduced to just a job, then it just becomes math. My fatigue is in the debit column, and someone else's nausea is in the credits; when they don't balance, then the question becomes, is this job worth it? And if it's just a job, then the answer is an unequivocal "no." In the moment, it's too demanding and thankless, and the level of investment is too high.

Not only that, but it's also difficult to ignore the simple fact that most doctors work in an environment where illness is the norm, and whether you acknowledge it consciously or not, it tends to reframe your perspective of the world. Because we can't really be upset at the sick people for being sick, we look for other reasons to be upset—and they're not hard to find.

Anyone who practices any element of medicine (nurses, doctors, the person who answers the phone) needs to be a shokunin (disclosure: I pulled this straight out of Jiro Dreams of Sushi). I think it's the only way.

The most miserable profession? Perhaps sometimes we are the source of our own misery. If we are expecting our coworkers; our executive bosses; or, possibly worst, our patients to deliver to us our sense of value, we are begging to be miserable.
I personally can't claim to have mastered the alternative, but I'm trying to stay on this road as I hit the homestretch in training. We're not only building a knowledge base—we're learning a craft. Which gesture is most reassuring when a patient who is newly diagnosed with cancer starts to cry? How can I most respectfully conclude a well-visit so that I'm not late for my next clinic patient? What is the most helpful thing I can do for a colleague who is clearly bearing the emotional weight of the suffering that cancer is inflicting on his patients?

I wonder whether the most misery is born when we substitute these micro-issues for macro-problems over which we as individuals have no control. From my current vantage point, I cannot fix the potential system breakdowns instituted by new federal legislation. I cannot restructure the reimbursement system that ensures that fewer doctors are practicing primary care (perhaps the most essential branch of medicine) every year. I cannot stop people from getting sick.

I can spend a little more time each day learning about the thousands of diseases that fall under the purview of hematology and oncology.

I can try to stop worrying about why some medical specialties are reimbursed more highly than others—or worse, why some industries in the United States offer far better lifestyles and 10 times the compensation.

I can remember that I chose to pursue a profession that means sometimes I'll have to go into the hospital at 10:00 at night because that's the hour that someone happened to get sick. That I might have to deal with paperwork that I consider ridiculous because it means the difference between a patient getting the medication she should have rather than the one the insurance company wants her to have. That I have to learn to cope with the persistent reminder that we human beings cannot out-eat, out-supplement, or out-lifestyle our vulnerability to any number of awful diseases, and that no one is exempt.

See:  http://www.medscape.com/viewarticle/847178?nlid=83489_491&src=wnl_edit_medp_wir&uac=60196BR&spon=17&impID=756168&faf=1#vp_3
See also:  http://kenbishop.squarespace.com/outliving/