The only way to know what you like is through experience. After over a decade in medicine, I now know that what I like about it is:
- Getting to know my patients as people (this is my #1 favorite thing)
- Solving puzzles
- Learning
- Helping
- Teaching
I don’t like:
- Publishing papers
- Getting interrupted / woken up
- Being responsible for a very wide range of problems
- Following protocols meticulously
When I was in medical school, I read a few books adjacent to medicine. One was called “My Own Country” by an HIV doctor, who worked in the rural American South. Reading this book, I got the idea in my head that being a general practitioner was “real medicine.”
Yet my experience in internal medicine was not enjoyable. I found being responsible for a wide range of problems, and medical knowledge, to be overwhelming. I didn’t like — and wasn’t good at — being the “manager” of someone’s entire body. After I changed fields from medicine to neurology, I found it far less stressful and more rewarding to be responsible for a single area than the whole enchilada.
While in neurology, I found, after a few years, that I didn’t enjoy inpatient work as much as I thought I would. Though I found the diseases intellectually interesting, the workflow of constantly being interrupted didn’t suit me. So I changed to a more outpatient-focused position where interruptions are minimal.
In addition, in the outpatient world I found that I had more time to get to know my patients as people. I find that when I can glimpse into who people are outside of their diagnosis, my work becomes more meaningful. I did not know, going into medicine, that this would be what I like most about the work. I entered medicine for the medicine. I’m staying because I like people.
Over a decade ago, I read the books, “Surely you’re Joking, Mr. Feynman” and “For the Love of Enzymes” and “Advice for a Young Investigator,” which gave me the idea that it would be awesome to be a scientist. To make discoveries. To follow my curiosity.
My actual experience in science was different from the picture I got in these books. Over many years, I worked in four different labs. I studied the cell biology of aging, tissue engineering, biochemistry, and neuroscience. I was super-interested in each of these topics. Yet, the day-to-day, boots on the ground experience of working in these fields was not something I enjoyed or was good at.
When I worked in research, I found that a tremendous amount of patience was required: organized notebooks, following protocols meticulously. I realized that my nature is to be an intuitive cook — a little of this and little of that — not a fastidious baker.
OK, I thought. Maybe I don’t have to be in a wet lab. Yet, when I took on the project of writing a review paper, on a topic I enjoyed (meditation), the process was still excruciating. It seemed that wherever I tried to enter the world of research, I couldn’t find flow.
The writer Mark Manson asks the following question: what’s your favorite flavor of shit sandwich? By this, he aims to underscore that every path involves failure on the way to gaining competence. For me, the path of studying was somewhat enjoyable. I’m naturally a pretty good student and test taker.
Yet the practice of science or medicine is not really about studying. Being a scientist is about working in the lab and writing papers. Being a doctor is about seeing patients. I realized, only through experience, that I enjoyed the latter but not the former.
Manson asks another fecal-themed question: what makes you forget to eat and poop? By this, he means: where do you find flow? Where do you enjoy the process?
I don’t think it’s possible to answer this question without actual experience. I can read books about something, I can talk to people who do it, I can even shadow people, but until I’m actually doing something myself, for a decent chunk of time, I won’t know if it’s my thing.
I like the process of rock climbing. If you put me in a rock climbing gym, I can hang there for hours and get into a flow state. The workout happens naturally. If you put me in a standard gym, I can force myself to lift weights, but it’ll be a slog. This knowledge about what kind of gym I like came only through trial end error. I don’t mind falling off rock climbing walls. But I don’t like the repetitiveness of a standard gym. So my favorite flavor of gym shit sandwich is rock climbing. Rock climbing makes me forget to eat and poop.
There’s this common advice that goes: do what you like. Yet, I think that the doing is the second part. The first part is knowing what you like. And this knowing can take decades to arrive at, and a whole lot of tweaking and self-reflection.
Knowing that I like “medicine” was just the first approximation. It took a whole lot of tweaking to find a practice setting that has enough things that fulfill me where it’s sustainable. My current job isn’t perfect, but reminding myself the above lists helps me to realize that it’s pretty good.
I saw a patient yesterday whom I feel like I’m really getting to know as a person. I’m working on a difficult diagnosis in his case. I don’t think I’ll be able to help “cure” him — but nonetheless, the process of working towards some kind of answer, and getting to know him in the process, is meaningful.
In my medical school essay, I wrote about my experience working with an eye surgeon in Ghana who helped restore sight to thousands through cataract surgeries. This was the model of medicine I had in my mind: doing great good for people through treatments.
I’m a different kind of doctor, I’m realizing, a slower kind. I like to know people’s stories. I’ve expanded my definition of helping. Yesterday, I saw a patient with headaches. I prescribed her a pill for migraines, but I spent much of the visit talking about the stress in her life and who she is as a person. We did a meditation together and she told me about her job, where she’s from, her family. I found this process of getting to know her the most meaningful part of the visit.
Let’s say that the pill works magic and cures her headaches. I’d be happy about the result, but my main meaning would come from the knowledge of what this improvement means for her in the context of her life.
It’s taken me decades to “know what I like.” Lots of trial-and-error and reflection. “Do what you like” is like an advanced graduate-level program. “Know what you like” is the first step and has taken me a whole lot of time.
danscreativeoulet 