A recent
post by
FreshMD (who is, incidentally, an acquaintance from undergrad and married to a former dormmate of mine) got me thinking about personal qualities and medicine.
In the last few weeks, I've also been speaking to several people who didn't get into medical school in North America, and had to do the Caribbean/Overseas route, about why we didn't get in and what it is about us and our stories that make us poor candidates.
In her post, FreshMD, listed attributes that make a good physician (as described to her at a conference she attended):
control
perfectionism
competitiveness
dedication
perennial caretaker
emotional remoteness
And in looking at her list, I really don't identify with many of these; this is not who I am. It's no wonder that admissions committees threw my application out. I am clearly not good doctor material.
Disclaimer: In using this list to riff on what makes a good doctor, I am not implying anything about FreshMD; in fact, I have always had enormous respect for her, as a enormously talented and wonderfully humane person.
And in my riff on what makes a good doctor, I am using these words in their more negative connotations. I know there are positive connotations to all of these words, but that wouldn't make an interesting blog post, now would it?control: I am fairly laid back, and don't struggle for control. I ascribe to the idea that the only thing I can control in this life is myself; my actions, thoughts, and emotions, and that trying to control things outside of me is futile. I also ascribe to the idea that in getting things done in a team situation there is a huge difference between control and leadership; the one being micromanaging bullshit, and the other empowering other people to be and perform their best.
perfectionism: I reject perfectionism as a deeply unsatisfying and ultimately soul-destroying philosophy. I do embrace excellence; knowing, however, that in my pursuit of excellence I will never reach perfection. In my own personal experience and in my own observation, individuals who are perfectionist are usually deeply insecure and use their unattainable pursuit of perfection to validate their own sense of worthlessness. By never achieving the perfection they so desperately pursue, they are able to say "See, I was worthless after all."
I say this as an artist, who has had to come to terms with the fact that the art I wish to create will never be realized; that even when I am performing at the very highest level, my performance will NEVER match the vision and ideal I have in my soul. Perhaps it's too Platonic, but it is the reality on the ground. Perfection is impossible (and quite possibly boring), so why pursue it? Excellence, on the other hand, with it's inherent possibility of disaster, is imminently desirable (and possibly a bit more exciting) and I embrace it wholeheartedly.
competitiveness: I was always the kid picked second last for choosing teams in the playground. As a child, I was viciously uncoordinated and suffered from undiagnosed exercise-induced asthma. Needless to say, I was not a good athlete. I developed an intense hatred for team sports, and preferred those athletic endeavours where I was competing solely against myself; track, badminton (singles), etc. I was also a good musician (blessed with parents who recognized my gifts and sacrificed a great deal to provide me with a way to train them), and loved the fact that when I was performing, I was the only person responsible for what happened. (That changed when I started to work with conductors and pianists, who can be [and often are] completely incompetent and can singlehandedly wreck a fine performance. There is an element of teamwork to music making that cannot be ignored. But I digress...)
I still don't get why I should be forced to compare myself with someone else. Their journey is different from mine, we both have different experiences and opportunities. We both have different strengths and weaknesses. And while in medicine, we can not ignore those aspects we are not good at simply because "it's not part of our journey," I think a much healthier approach is to measure ones self by comparing my performance today with my performance yesterday. If I see an improvement (and if there is an improving trend) in something where I need improvement, then I am happy. If I am not improving, or am remaining the same, then I have something to work on.
As part of our clinical skills training, as a member of a small group of students, we were given the opportunity to conduct a patient interview with a standardized patient. The few times that I interviewed, I did very well. Several members of my group complimented me on my interviewing skills, and while I appreciated their comments, I was somewhat uncomfortable with their praise. As a private music teacher, I'd spent the previous 7 years conducting one-on-one interviews with my students in a very similar environment. They came to me with something they wanted to improve, and it was up to me to figure out what was wrong and how to fix it. That experience (and the fact that while shadowing my sister, I had interviewed several patients) meant that the interview was not a scary thing for me, and I had skills honed over several years that allowed me to do well. We all come to medicine with various experience and abilities that help define our strengths and weaknesses; why should I compare myself to someone else and beat myself up for not being that person? It is my job to determine what my weaknesses are and work to correct them. And why should I be singled out for praise when the reason I am good at something amounts to little more than an unconventional background and a series of coincidences?
dedication: Dedication is a good thing. But there can be such a thing as too much of a good thing. I was never one to consider immolation. I suppose I am one of those lazy new types who isn't willing to give up everything for the sake of my career. I will be dedicated to my patients. But I will also be dedicated to growing as a human being and as an artist. I will be dedicated to living a full life in my community. I see life as a constantly shifting priority list, with medicine at or near the top. But while medicine will often be at the top of my list, it will sometimes lose place to other priorities. Does that make me less dedicated? Perhaps. But I suspect I will gain more than I lose.
perennial caretaker: Also a good thing. But again, there can be too much of a good thing. I believe strongly that in order to care for others, we have to care for ourselves. To use a slightly hackneyed metaphor, if we pour our energy into others, we have to find a way to replenish what we have lost. I believe strongly in feeding my own soul so I will have the energy and compassion for others.
One of the labels I use to describe myself is "Healer." But in trying to heal others, I am completely aware that I cannot force change on individuals. I cannot control their choices. My only tool for effecting change is my powers of persuasion. In many respects, I consider myself more of a salesman than a healer. After all, what are we doing beside selling miracle cures?
emotional remoteness: I see what the author of this list is getting at with this one. It is impossible to enter into all this suffering around us as medical professionals without being destroyed. But I object to the word "remoteness." It carries with it the idea of withdrawing, of being apart from our patients, of not being there when they are hurting. I think a much better word would be "stability." It's a hard concept to explain, but I am a proponent of being there in the emotion, acknowledging it, perhaps even experiencing it, but not being blown away by it.
It's probably my training as an actor that gives me this perspective. One of the methods of acting training popular in North America is to find the emotion inherent in a particular character/scene/line, experience it, and let it inform the choices we make on stage. So what we do on stage is about exploring the emotion, without letting it overmaster us. I don't want to remove myself from my emotions. I want to maintain emotional stability, and even emotional control. But anything more than that, and one runs the risk of suppression or repression.
I found this list interesting. It's clear to me that I don't possess many of these attributes in a strong way, and that I am clearly not fit for medicine. Or does this list represent what is wrong with how physicians are recruited, trained, and mythologized?
In discussing with singing colleagues on how to build a career as an opera singer, a phrase came up that I have never forgotten. "In order to make a living as a singer, you have to be psychotically determined." In many respects, medicine is similar. One really does have to be crazy to inflict this on ones self. But as we undergo our training, and reshape ourselves in the image of our profession, I don't want to become someone who is controlling, perfectionist, ubercompetitive, psychotically dedicated, a perennial caretaker, and emotionally stunted.
So here's a new list:
A true leader
Pursues excellence
Dedicated
Balanced
A healer
Emotionally stable
What do you think?
