Monthly Archives: June 2024

The Doctor’s Dilemma

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Being a physician is a career that can become one’s life. There are many reasons for this including the 24/7 need for healthcare, the pressure from healthcare business for productivity, the need for advocacy to improve the system and increase health equity, and the desire to help others. There is also the added stress that medicine literally deals with people’s lives and wellbeing. Given these career features, being a physician historically was a way of life, not just a job.

Despite the historical trend that being a physician was a way of life and an identity that trumped all others, there has been a shift in recent years. This shift started some time ago and was, perhaps, expedited by the COVID-19 pandemic and the severe toll it took on all healthcare workers. The shift is that newer ages of physicians don’t just seek to be doctors – they seek to be partners, parents, athletes, cooks, travelers, readers, vacationers, relaxers, and gardeners to name a few identities they claim beyond the physician identity.

As a member of the newest generation of physicians I find myself caught between the old dogma that to be a physician is to prioritize it above all other aspects of life with the newer view that to be a physician is to be a person with a serious career. I think of these completing identities of “way of life” vs “profession” as the “doctor’s dilemma.”

Sometimes self-imposed and sometimes externally-imposed the training physician (and all physicians really) are driven to do more. More reading and learning, more shifts, more leadership roles, and more research. It’s hard to balance the forces urging me to do more with the desire to also do nonmedical things like spend time with my husband, hike, and write. My medical training has taught me to hustle, be efficient, and work for long durations of time with high focus. As my training continues, I’m also learning how to say “no” and pump the break. Of course, these learnings are contradictory. The pendulum falls sometimes more on the hustle side and sometimes more on the relax side.

As I finish my 1st year of residency, I’ve been thinking about the doctor’s dilemma because in the remaining years of residency I’ll make decisions about my post-residency career path. While I contemplate my career’s trajectory, I also find myself thinking about other things in life. For example, living in a city apartment has made me miss walking barefoot on grass. I don’t suspect I’ll own a house anytime soon, but missing grass has made me think about homeownership more than ever before.

What do I put on hold and what do I pursue? What opportunities if not taken now will disappear? Where do I want to be in 5 years?

While wellness preaches “live in the moment” heavy careers, like doctorhood, require forward thought. Doctorhood requires the balance and blend of one’s professional dreams and identity with one’s personal dreams and identity. During my 2nd year of residency, I’ll become a team leader and gain more independence. With this greater responsibility doctorhood feels more serious than it did as a new resident when I had more people guiding me. As my training continues, it is my turn to step up with the answers. Patients will depend on me. Each choice, like whether to study or run, has a ripple effect on my future and (perhaps) on my patients’ futures. There simply isn’t enough time to “do it all” at the same time. Choices must be made along the way. The choice options are what pose the dilemma.

A Letter to My Intern Self

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Dear About-To-Be-Intern Self,

Intern year (as the first year of residency is called) is going to be tough. At times, in fact, it’s going to be downright awful. There will be stretches where you don’t see the sun and can’t remember the last time you felt anything but exhausted. The trend you noticed in medical school, in which current physicians and administrators don’t value your time (and waste it) and then wonder why your mental health is poor, will persist. You will be told by some to do more because “you’re a doctor now” and you’ll be belittled by others because you’re new and you don’t know what they think you should know.

You will be impressed by how your health deteriorates intern year. You are welcome to take some of the blame for your decline if you’d like, but the truth is that everything about intern year is the opposite of the wellness advice we give our patients. From your sleep schedule to your stress level, or from the food the residency program gives you to your work hours, there is very little healthy about intern year. It would be misleading to ignore these negative things that will unfold, one way or another, as they have for every intern. They manifest a bit differently for each person, but their occurrence is a guarantee.

Like all things in life, the negative of intern year is paired with the positive of these 12 months. First off, you’re paid – a huge victory after 4 years as a medical student. Your salary will be meager compared to your future salary (and it will be poop if you calculate the hourly rate) but remember that the intern salary is higher than the average annual income of Americans. Second, you are a doctor now. A real doctor. This title, alone, allows you to meet the most extraordinary people and hear their amazing stories. People will tell you things they never told anyone else. Your kind patients and your brave patients will be beacons helping you through intern year.  Focus on remembering the kind and brave patients more than the hard and mean patients; it’s the opposite of what your mind will want to do. I assure you that remembering the kind and the brave will help you more than you realize.

There will be difficult senior residents and supervising physicians; there will also be amazing ones. Take a moment to appreciate the inspiring senior residents and supervising physicians and reflect on why you respect them. You’ll be in their shoes before you know it and you can learn from them. Let the degrading and unkind supervising physicians and residents bounce off you; let them be a lesson of what you do not wish to become. The same goes for the nurses and other staff in the hospital. Nurses will be your biggest nightmare and your biggest savior throughout intern year. A knowledgeable and respectful nurse is gold. Thank the hard working and thoughtful nurses. Learn how to navigate the mean and not patient-focused nurses. You’re a doctor now and, once intern year is over, you’re going to be a team leader. Intern year is about getting ready to be a leader.

No one is good at being an intern when they start. Every intern gets better at medicine, navigating the healthcare system, and working with the interdisciplinary teams of healthcare. You won’t notice how much you’re learning at first. The days will pass slowly and the weeks quickly – before you know it, you’ll wake up and realize that you are a new version of you. You’ll blink and a new July 1st will be just around the corner. Then, intern year will be behind you…forever. I’m not delusional enough to say, “enjoy it while it lasts.” I am delusional enough to say fight for your health (because you’ll need to) during this year and soak up as much knowledge as you can. In the end, intern year exists to help you get closer to becoming the best doctor you can be. Intern year will force you to grow. It will challenge and push you to a new level. Always remember that intern year is finite and only one small phase of the Doctorhood Quest. It will pass.

You go this. I know you got it. At the end, you’ll know you got it too.

Yours truly,

Jett

Space

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I often think about space, specifically taking up/claiming space. My most conscious ponderings about space are while I’m running in the park near my house. I’ve observed that people are more likely to step aside for a male runner than me, a female runner. It’s so blatant that when my husband and I are running or walking together we strategically put him on the outside because people move over for him and not me. It’s an annoyance. I’ve started to run strong and serious. I’ve learned that a confident stride and a squared shoulder do help remind people that women also deserve to run without stride interruptions.

Guarding my lane while running is a newer claim of space for me. The first time I claimed space was changing how I sat. Changing my sitting stance was a project that took the better part of my twenties. For some reason women in my culture are taught to sit small and closed. I’ve found that sitting small is counterproductive. It has (perhaps) made it easier for males to harass me on public transportation and (definitely) made it easier for my colleagues in healthcare to ignore me. These days I try to sit large and open, just like my culture teaches their boys to sit. I don’t take the inside seat on the train/bus (that’s more for safety as I’ve learned the hard way) and I take up my whole seat even when it’s wider than I am broad. If there’s a seat at the table in a conference room, I take it. Which brings me to medicine, my most recent occupation (both meanings of occupation, wink, wink).

I have a very distinct memory from medical school related to being a female in medicine. I was mid-sentence presenting my section of a group presentation when a male member of my team cut me off, talked over me, and started his section of the presentation without letting me finish. It was so rude that several females in the class texted me in solidarity. The experience made me think about why seats at the table are not enough on their own. Seats must be claimed and, sometimes, defended.

Being a first-year resident brought with it a whole host of interesting space claiming challenges, many simply related to being a new doctor and some related to being a female physician. Filling the role of physician involved learning how to defend and explain my medical decisions, striving to take the high road and set boundaries when other members of my interdisciplinary team did not, and observing how physicians I admired conducted their doctoring and led their teams so I could model their techniques.

The challenge of being a new doctor exists for all new doctors. But filling the role of a female physician comes with its own occupational hazards. Here are some concrete examples from the past year of times I was reminded that I was female while at work:

  • I frequently must remind my patients that I am not their nurse — a challenge that my male counterparts don’t have.
  • My name is gender neutral, so nurses often think I’m male when communicating electronically with me before they meet me in person. (We have a secure chat in our electronic health record system that we use in the hospital). It is interesting to see how nurses’ tones change after they discover I’m female when they originally thought I was male. At times the tone change is dramatic and frustrating because I get more pushback as a female than as a male physician.
  • I have been lectured by a male supervising doctor about what clothes a doctor should wear. The lecture was somewhat confusing given that all the female residents wear exactly what all the male residents wear… scrubs of similar fits, styles, and colors. I doubt any male resident teams have been subject to such a lecture, but my all-female resident team was.
  • Several times I have found myself uncomfortable on rounds (that time of day when you talk about all your patients with the supervising doctor) because the male supervising doctor was very good at looking at my chest but never made eye contact.

The above situations illustrate that there are additional features of the medical terrain that female physicians must navigate that their male counterparts don’t experience.

As my second year of residency approaches (starts July 1), I’ll soon find myself no longer a first-year resident. In my second year of residency, I’ll start to be a team leader and I won’t be the new kid on the block anymore. I’m excited about this next step in my training. I feel ready to take on the challenge knowing I’ve learned a ton already and have a ton more to learn as a physician. I continue to have much opportunity for growth on my journey to lead with humility and excellence. As I wait for my second year to begin, I’m curious what the phase of “senior resident” (my title during my second and third (last) years in residency) will be like and the space challenges it will present. All adventures have space challenges however they present themselves in different ways.