Edwin Leap, MD, believes that physicians are unhappy because they believe in the great lie:

What was it? What was the lie and when did doctors learn it? The lie was this: ‘if you become a doctor, your profession of medicine will be all you need for happiness and fulfillment.’ In short, physicians learned to validate themselves by way of a profession.

He reminds us that medicine is, at the end of the day, simply a job, not a “reason for being.”

Graham Walker, soon to be MD, believes that the younger generation of physicians do not believe the lie:

We knew we wouldn’t make the most money (or at least, we should have known this); we knew that medicine was time-consuming, but we chose it anyway.

Graham later comments:

Look at the fields that are incredibly popular today: they either make a lot of money, offer a good lifestyle, or both…. We want to have free time outside of our careers. We want to have families and relationships. Sure, we’re ready to make sacrifices, but we weren’t told a lie–or maybe we just never believed it.

The thing about medicine, like many things, is that you don’t really know what it’s like until you actually work as a physician. No one really knows what it’s like to work thirty-hour days until you actually work thirty-hour days. No one really knows what it is like to witness a patient die until you actually see that first patient die. No one really knows the feelings of incompetence, fear, and frustration of an intern until you’re an intern. No one really knows just how much paperwork there is until you’re the one who has to fill it out.

And, of course, no one really knows what it is like to help someone get better—whatever that may mean—until you’re the one doing it. No one really knows what it is like to sit with someone who is dying and offer comfort when that is the most desired course of action. No one really knows what it is like to have ongoing relationships with people and play a significant role in the optimization of their health until you see them healthy (if not healthier), year after year.

Edwin Leap writes of a former expectation that medicine would provide everything—financially, emotionally, cognitively, socially, etc.—for the physician.

Graham Walker writes of a current expectation that medicine can provide some things, but not all things, for the physician. He expresses confidence that we have the time and capacity to find satisfaction elsewhere.

Both expectations continue to compete—if not clash—in the current practice of medicine. There are still those physicians who insist that medicine is a life calling and express disapproval for the younger generation of physicians who seek well-rounded lives. Some of these physicians are the supervising attendings for the younger generation.

The work in medicine can be consuming. Though most of us soon learn that humans often heal in spite of, not because of, our efforts, patient and physician can collude in the belief that the physician is actively “doing” something to help the patient feel better (again, whatever that may mean). Physicians, for the most part, are nice people—they think and worry about their patients. Sometimes, that consideration morphs into guilt and though we may “want to have free time” and “families and relationships”, we find ourselves pulled into the belief that we are squandering our skills and potential if we are not tending to our patients (through direct patient care, reading, studying, etc.) as much as we can.

There are a lot of interns (and residents) out there who are working many, many hours per week who berate themselves for not reading “enough”. “Enough” is always more than what the intern is currently able to read.

And though it is true that medicine is a just a job, the job description of a physician often means different things to different people. There may be misalignment of expectations between patient (”the doctor will fix me”; “the doctor is a quack”) and physician (”there’s nothing I can do to help this person”; “this person won’t follow recommendations that will probably improve his health!”). Merriam-Webster defines medicine as

the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease

That’s a really vague definition. It encompasses many different things.

Furthermore, when people ask doctors what they do for a living, how many physicians say, “I work as a doctor”? Medicine can overwhelm our identities, which is why most physicians say, “I am a doctor.” (Indeed, that may just be semantics, but the words we use reflect the thoughts we have.)

I mean no condescension or disrespect to Graham when I write that it is challenging to achieve all the things you want in your life while working as a physician. The population that enters medicine tends to be full of ambitious types who do boast a variety of interests. As trainees, at least, it is difficult to balance all of these pursuits. Because of the amount of time physicians in training spend at work, other interests—hobbies, relationships, etc.—can easily fall by the wayside. Sometimes, we purposely choose to direct our energies towards our non-doctorly lives to re-establish equilibrium… only to sense (later) that we are letting our patients (and ourselves!) down because of the shift in our priorities.

The point of equilibrium constantly moves.

Maybe the lie for the younger generation of physicians is that you can work and play.

We shall see.