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What makes it OK

Every now and then, I get email from pre-med types who are having a lot of trouble deciding whether to go to medical school.

Dear Dr. Signout*,

I was supposed to start medical school last week, but [I've deferred for a year to figure things out.]

I guess the thing is, I like living so much, and medicine seems both incredibly in line and at odds with that–you give up everything you’ve ever been passionate about to live, to the extreme, one particular passion.

I know that what-ifs are horrible exercises of futility, and that denial and self-rationalization are crucial elements of happiness, but I was wondering anyway: would you do it over again knowing what you know now?


*This email has been edited to preserve the writer’s anonymity and enforce the use of Standard English.


For starters, “what I know now” is merely medical school and residency. I haven’t even tasted independent medical practice yet, so that limits my perspective. I’ve asked for some more experienced practitioners to add their thoughts in the comments section.

I had a hard time choosing to do medicine. The idea was never mine to begin with–it came from my parents, along with a lot of pressure to quit dreaming and do something. In part to get away from that, I took a substantial amount of time off in between my undergraduate time and medical school. By the time I started medical school, it seemed that my exhaustion from prolonged directionlessness had landed me there as much as anything else had.

A few things kept me from being really enthused about medicine, among them my lack of talent for science and my preference for creative efforts over academic ones. I desperately wanted to make one of those creative efforts into a career, and did some work in different sectors, but there was something that routinely needled me: every time I encountered someone disabled, dysmorphic, homeless, or otherwise disadvantaged, I felt impotent. My impulse was to face those people, talk to them, and give them comfort, and I had very little context in which I could do that appropriately and constructively. I ultimately didn’t feel I’d satisfy that impulse in any of the creative fields, so I started to look elsewhere.

After applying to medical school and getting in, I had the same problems with what-ifs that you do. The unsuitability of other career paths did not make medicine feel like a better fit. Once made, the decision did not settle easily: I spent most of my first year of medical school pretty depressed, and felt a great sense of loss that took a long, long time to go away.

What makes it OK now, eight years later, is the mix. I am fundamentally the same person: I still need to have creative outlets and people in my life, and I still have an impulse to offer something to disadvantaged people. When I’m able to satisfy both desires in one day, that’s a good day. Happily, I’ve also discovered a real joy and fulfillment in things I never thought I’d like much, like teaching and research. This only expands the list of things I can do when I’m done with my training (not to mention, while I’m in it).

As I mentioned already, I haven’t reached my own career nirvana yet. There are definitely times when I feel that medicine has taken over my life, but as I work my way slowly upward, some of the things that were squeezed out are getting squeezed back in. The symbiosis of my medical practice and my writing is one that I’m not sure would’ve evolved out of any other career choice, which helps make me feel pretty good about things. My point is, although there are parts of the training where medicine certainly dominates, it’s not that way forever, and the variety in your life depends largely on you.

There’s still a part of me that wonders how things could’ve been if I’d had more faith in my ability to make another career path work, but that’s the kind of person I am–I look back. Still, one thing I know for sure is that if I were doing anything but this, I’d still feel a catch in my throat every time I saw someone in need. It’s nice not to have that any more.

I’m not a huge fan of inspirational quotes, but I like this one from Howard Thurman: “Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.”

Others’ thoughts?

Comments

  1. #1 T. Bruce McNeely
    September 1, 2008

    A few thoughts from an veteran MD:
    The quote from Thurman is Right On. I’m keeping that for my daughters.
    Consider getting some experience (paid, volunteer, etc.) in a patient care setting, or clinical or research lab if that’s more your inclination. I was lucky to be able to work summers in a clinical lab when I was an undergrad student, which revealed that I was a good “fit” for clinical lab medicine.
    There are all kinds of specialties and practice settings. Find out what they are before making up your mind. There’s a place in medicine for many different kinds of personalities.
    Medical school can be brutal, but it’s only 4 years. However, it seemed like 4 centuries at the time. Residency and practice will be easier.
    When choosing a vocation, choose what’s right for YOU, not what others regard as “cool” or prestigious. This will save you a lot of pain.
    My best wishes to anyone in this situation.

  2. #2 tleeh
    September 1, 2008

    I see becoming a doctor as similar to joining the priesthood: it’s a lifestyle and if you quit you’ll always be known by your former profession. That scared me in undergrad because I didn’t know if I was thinking about medical school for myself or for my parents, so I choose not to do the MCAT and try to “find myself” in a MSc. I hated the Master’s but I do think it was very helpful to try something else first and determine what I liked (the application of science) and what I hated (no human contact). It helped me grow up and not have regrets in medical school. Also, having some time away from the pre-med focus of undergrad makes you realize there’s more to life than medicine. It’s the balanced people who make better doctors. I only finished last year. It’s more fun as staff but actually much busier so I’m finding it hard to get my balance again!

    I think the most important part is to do it all for yourself. You won’t want to work at 3am if you’re just doing it for your parents or for the prestige. Also, I recommend you ask your parents… turns out mine wanted me to be a lawyer (oops :)

  3. #3 PalMD
    September 2, 2008

    Sometimes I wish folks were required to take a little time off before they commit to med school (as both Signout and I did), however, the length of training required makes this impractical.

    The career is, for most people, a lifelong commitment and for many it is all-consuming. More and more, however, it is becoming possible to balance a family life with medicine, especially in primary care.

    One of the main barriers in the US is the price of education. The debt burden felt by most doctors drives them out of primary care medicine, giving us a relative deficit of good internists.

    Many doctors are polymaths—writers, musicians, surfers, but obviously, these things are relegated to hobby status. Still, medicine does not require one to abandon a creative life.

    I always tell people that they shouldn’t go to medical school unless they reallyreallyreally want to be a doctor. If they don’t, it’s expensive, depressing, and you’ll make a lousy physician. If you do like it, though, you won’t be able to imagine doing anything else. I wouldn’t change a thing.

  4. #4 Signout
    September 2, 2008

    Thanks for the thoughtful responses! Allow me to point gentle readers to Orac’s blog for his take on the what-ifs.

    I’d also invite prospective applicants and even the inexperienced among medical trainees to chime in, whether with questions or with comments, right here.

    Carry on.

  5. #5 Devilbunny
    September 2, 2008

    I’m in my final year of an anesthesiology residency. My wife is in neurology, one year behind me.

    The best explanation I’ve ever heard of medicine was used in the context of high school football in the South (i.e., somewhere really hot). “You’ve gotta love it – because if you don’t, you’re a dumbass for being out here.”

    It is a major commitment; you will spend your twenties working in a hospital while your friends travel, have fun, and earn a lot more than you (at this point in my life, my wife and I put together earn less than any one of our friends does alone). But you get to see and do things that nobody else does. I’ve anesthetized people for thoracic aorta procedures that required putting someone on bypass and then, for the crucial portion of the procedure, turning the machine off: no blood flow, no oxygenation, nothing. For twenty minutes. Then we turned the machine back on and brought what was by every imaginable definition a corpse back to life. I don’t think I’ll ever do anything more astounding than that.

  6. #6 Erik
    September 10, 2008

    Starting as a medical student and continuing to this day I try to dissuade people from going to medical school. Not because I hate medicine (although there were some months…) but because I figure that if I can talk them out of it they probably don’t have the enthusiasm for medicine that I think they’ll need to get through some of those darker days.

    Devilbunny: I agree that the loss of your twenties to medicine is one of the biggest sacrifices. Starting a family in my mid thirties instead of my mid twenties is one of my biggest regrets. That said, total circ arrest cases do tend to help balance that out!

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