The Selfless Divide
The Selfless Divide
Do you miss it? I get asked this question all the time about leaving clinical medicine. After twenty five years of seeing patients in one form or another, I have taken a more administrative role in my half retirement. I discuss individual care with our hospice teams, but don’t do any visits myself. This last few months has been a radical departure from my previous professional responsibilities. And my resounding answer to the question is no. I don’t miss it at all. In fact, I’m finally starting to feel like the old me. Quick with a smile and long on patience. Funny. Relaxed. It took all this time to realize how much I have changed over the years. It took me all this time to finally cross back over the selfless divide.
The Medicine Fallacy
There is a great big lie, for me at least, about medicine. That I went into it to help other people. That it was some supreme selfless act. Sure, some of that is true. But now looking back on my career, becoming a doctor was actually fairly selfish.
As a kid daydreaming about being a doctor, I had no real concept of what helping others really meant. There was no cognitive understanding of what being a physician really was. I was caught in an egotistical yearning to one day be of importance. I wanted to be relevant.
This no way discounts my true hopes and wishes to make the world better. But I was far from crossing the selfless divide. My motivations were more based on the idea of who I wanted to be and how I wanted to perceive myself.
The Early Years
This played itself out in a fairly pedestrian manner over the beginning years of my career. I was so caught up in the act of becoming there was little time to question the profession or even my own deeper intentions.
Everyone around me was patting me on the back and telling me how selfless I was being. This made it easy to work long hours, ignore my own mental as well as physical health, and sometimes be crappy to the people that I love. All deeply self centered actions when looked at through a particular lens.
It made me feel important. I was straddling the selfless divide and still falling back to the selfish side.
Burnout
There are volumes today written about physician burnout. But boiled down, burnout is somewhat a consequence of realizing that your perceived selfless acts are for naught. You start to feel that you are no longer helping people, not making a difference in the world, and reviled and hated at times for your best intentions.
You are not helping people. And, just as importantly, you are no longer feeding your own ego. You can no longer believe that what your doing sets you apart as different or more worthy. Your hands are tied behind your back as you watch others suffer.
The selfless divide collapses in on you. You are not being selfish or selfless. You are just being punished.
And that stings.
Final Thoughts
I don’t feel sad about leaving clinical medicine. I feel amazingly relieved. Now I realize that there are a million little ways to be selfless and kind without being so severely punished. I have come to a place where my ego no longer needs the hit of perceived importance. I have lost the drive for selfishness.
And thus have crossed the selfless divide.
I’m not sure if you found this easy or difficult to write but it certainly makes for an interesting read.
When we rip away the veil of what people (including ourselves) expect us to think and feel and instead look deep inside and articulate what we actually see instead, the results can be surprising and (at times) difficult to air in public.
I’m not quite sure if I’d be ready to air my own dirty laundry just yet, since I’m still very much ‘in the thick of things’ as they say.
HH
These type of blog posts come after a long history of examining why I do things as well as much practice being vulnerable in public.
I honestly feared I would miss being the boss of a large operation. No longer having hundred’s of employees and hundred’s of millions of dollars of expenses to manage. But what I felt was relief the day I left it behind. Just like you Doc. And that surprised me. You’d think we would have better self knowledge wouldn’t you? When I look back I now realize my job was impossible to do well, I never met my own standards and nobody else will either, it was a broken game. And I’m glad I’m not playing it anymore. Great post, and while we had very different careers I think we were in the same place in many ways.
Agreed. I think our paths are similar. Sometimes self knowledge only truly comes with change.
The “selflessness” of medicine was always a facade, and that facade has been relentlessly and increasingly co -opted by business types over the past decades. You want to be “selfless”, because it suits your personal immature 22 yo delusion of what is required to be allowed to be a a physician, and your “teachers” did nothing to dissuade you and everything to reinforce your delusion, because any dissent would screw with their delusion. It’s a sop to your pride. Have I got a deal for you! It’s part of the basis of the impostor syndrome and we do it to ourselves and allow it to be done to us with or without KY. In return we get an occasional extra ham sandwich from the drug rep, and a 50% cut in Medicare so we have to work twice as hard to stay even. Medicine would be a far healthier business if we blew up the facade. OH MY did I just call Medicine a Business, forgive me, it’s a calling! I swear! It’s a calling!
Ha! I agree. There is definitely a delusion that pervades our ranks.