The reason(s) why I left clinical medicine

From medical school interviews, to residency interviews, to discussions with friends and family, I have had to answer the question of why I decided to become a doctor literally hundreds of times.  In answer to this question, I would tell a story.  And, like all good stories, the ones I would tell contained a bit of truth and a bit of fiction.  I would try to balance what people wanted to hear a doctor say motivated him to enter medicine (or, at least, what I perceived people wanted to hear) with the truth.  The answers I would give varied and aren’t important right now.  Because part of what I want to do with this blog is to provide some true insight into of why I became a doctor and then left clinical medicine.   So, why did I become a doctor?  Here’s one true answer – I did it for the same reason that I run (or attempt to run) marathons.  Namely, it is a challenge that uses my capabilities to their fullest, leaves me stronger in the end and where success is not a fore drawn conclusion.  In my opinion those are the best reasons to do anything in life.

Got it, so why did you leave?  Based on my conversations with doctors over the years, I’ve come to realize that my love-hate relationship with medicine is far form unique.  The happiest doctors find their interactions with patients rewarding, don’t mind spending their free time reading journal articles, are well supported by capable office staff and have families that show understanding when unexpected, yet urgent, job related obligations arise.  But, even under the best of circumstances, there is no way to avoid the occasional phone call at dinner time about your 11:20 am patient…”Her d-dimer is how high?  Chest x-ray is normal?” (sign) Looks like I need to send the patient to the ER because she might have a pulmonary embolism.  Or do I?  Was she really that short of breath?  Maybe the d-dimer is more likely to be a false positive.  While I ponder the clinical scenario, I try to appear interested as my son excitedly shows me a robot he made out of a cardboard box.  Four minutes tick by, then five.  I consider all the possible outcomes: a) send the patient to the ED -> diagnose a PE -> save the patient’s life, b) send the patient to the ED -> CT is negative -> patient is ok but exposed to unnecessary radiation, time and expense -> dinner is ruined c) enjoy dinner with my family -> patient is ok,  d) enjoy dinner with my family, patient dies.  Crap, I’d better call the patient.

The above scenario is common and in no way rewarding.  Which is why, even in an ideal world, there are aspects of clinical medicine that kind of suck.  Rather that attempt to summarize everything about clinical medicine that compelled me be both to stay and eventually to leave in a few neat paragraphs, I plan to tell a series of stories.  I hope they will resonate with clinicians and nonclinicans alike.

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