Once in a great while, a patient asks me why I became a doctor. It surprises me that I am asked that question as infrequently as I am. Perhaps the average person assumes that doctors are born and not made, and that most of us “always wanted to be a doctor when we grew up”. I don't know about my colleagues, but I certainly didn't to start out with; neither to be a doctor nor to grow up. I'm still just wrapping my head around both.
The ingredients in making a doctor vary from individual and individual and even the same ingredients are mixed in varying degrees. The first assumption some people make is that doctors are motivated by a compassion to help our fellow human beings, while other more cynical patients assume we all went into it for the money. These are 2 ends of the spectrum, but few of us fall close to 1 side or another. And while there is probably a bell curve along this axis, there are many other axes. For example, it would be hard to find a pathologist whose lifelong dream to help others was by looking at microscope slides all day. Intellectual stimulation, curiosity, and the satisfaction of accomplishment all play a role. And while there are certainly a few doctors I know who calculated how they could make the highest income and chose medicine as the means, the majority of us had more complex and for the most part commendable reasons.
The first clue to an observer that I might have had “doctor potential” was my brains. (No, I won't assume a false modesty. ) This was apparent to family and friends even before I entered preschool. I was a precocious child and worked out how to do sums and multiplications up to past 100 even by the age of 3. My aunt, a teacher, enjoyed posing problems and I was delighted that I could solve them. This ability to come up with answers grew so that by the time I was in first grade, I was finishing class quizzes before my classmates had barely begun. At 1 point, my overtaxed teacher allowed me to help my classmates during quiz sessions. I distinctly remember one day a line formed at my “help” desk. I got a charge out of that because it made me feel important, respected, and in some measure, helpful.
The next ingredient in my career choice was a developing need to “fix” things. At an emotional level, I suspect the foundation was a wish to fix my own nuclear family. Mind you, I did not come from a broken home; far from it by conventional measures. But there was always a neediness in my parents' relationship that was worsened when my younger sister was born with what were at the time called some “adjustment problems” as a child. This worsened the family dynamic and even by the age of 12 I had a sense of deficiency in my parenting. I was even pressed by my parents into the role of emotional caregiver by the time I was a young teenager, although that brief period ended with the advent of teenage rebellion. I think this background may have contributed to my perennial urge to “fix” everything, whether it be a door that sticks, a workflow process that doesn't (work), or a shoulder joint that sticks. My wife keeps reminding me that it is not my role in life nor is it even my business to fix everything that seems to be functioning to less than what I think it should. But in a larger and more positive sense, the need to “repair the world” is one of the tenets of my religious (insert “lack of” here to be honest) faith. “Tikkun olam” is the Jewish phrase for repairing the world.
So far however, even by age 12, I regarded the medical profession only as a bunch of authority figures with needles. My interests were more technical. An inspiring science teacher saw my budding interest in electricity, which I was convinced was nothing less than magic. He lent me a box of telephone equipment and I was soon setting up an intercom for my parents to call me down for dinner. I took up an interest in modeling and found I enjoyed working with my hands. Soon this evolved into an interest in amateur radio, and before long I was building ham radios and studying for a license. At that point, the design and construction of radios so fascinated me that I set my sights on electrical engineering as a career. By high school I was even allowed to play with a new invention: a computer. In those days it was a matter of programming IBM cards in BASIC. But it was a chance to solve technical problems.
Meanwhile, a humanistic side was blossoming in direct parallel with the technical. I took an interest in writing. I wrote for and then edited the school paper. Then the yearbook. Then I started writing short stories and poetry. Stories mainly about people. I found that even on my Ham Radio, my main interest was in the other people I met on the air and not on the number of countries I collected or the construction of ever more complex radios. I changed my mind about career. I decided I was going to be a writer. I became a member of the high school literati.
It was at that point in high school that one of those—I hate to use the word epiphany—shall we say, formative moments occurred. You see, I had a crush on a classmate. It was not mutual, but we hung out in the same crowd. One warm spring day, we were seated on the expansive lawn of her sprawling colonial house when her father, a doctor, pulled into the driveway. The family Scottie dog came running, my friend ran to greet her Dad, and her Mom came out from the kitchen to greet him with a fresh-baked apple pie in her hands. This last part I think I embellished in my memory. I stayed for dinner and was treated to a tableau of what can only be described as a Norman Rockwell family, with Dad, the doctor, as the center of it all. I concluded 2 things from the experience: doctors make a good living and have adoring, happy families. Writers, I was coming to realize, live alone in garrets and eke out a living word by word. Maybe I could learn to be a doctor and write on the side.
By the time college loomed, I began brooding about the meaning of life. Somewhere, the quixotic notion of founding all ethics and science on a solid ground of a priori logic and factual construct entered my head. I started spending my study hall hours in the library reading all I could about philosophy. I went off to college and promptly signed up for a major in philosophy . But I was immediately asked by parents, relatives and friends how I proposed to make a living as a philosopher. Easy, I decided! Doctors make a lot of money, right? So why not be a doctor part time and philosophize in my leisure? I finally had an answer for the skeptics: I was going to be a meta-physician. Get it?
It was only at that point that I gradually took an interest in what medicine actually entailed. But what I learned was inspiring. First, I read a tell-all book entitled ”Intern!” by Dr. X, which chronicled the first year of a doctor in training who had spent some time at Johns Hopkins, wherever that was. What adventure! Life and death! Saving lives! Now that's what I call the meaning of life! By the time I was a college senior, I was had applied and was admitted to—guess where—Johns Hopkins Medical School. I waited for graduation day and studied works of medical history such as Cushing's ”Life of Osler.” I found all kinds of medical historical reading to occupy the time that I was studiously devoting to not studying
I entered medical school in September 1974 and found it was a major adjustment after a life of liberal education. But that's a tale for another post. By that time, even before donning a white coat, I was already becoming a doctor.
David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.