My intention with sharing my path in medicine is multifold. I wish to demystify the monolithic perception of the medical profession, shedding light on the multitude of motivations that drive individuals towards this vocation, and the diverse experiences encountered within. I want to lay bare the struggles, insecurities, and ethical dilemmas I've grappled with, in an environment that can often feel stiflingly hierarchical and rigid. Yet, in parallel, I aim to highlight the capacity for self-discovery, transformation, and fulfillment within this same realm.
As someone who has been steeped in medicine and physician culture for the past ten years, it’s easy to see now that people go into medicine for all sorts of reasons. My own naivety is a curse and a blessing - I had thought that the only reason people became doctors was because they wanted to be a healer and wanted to care for people.
But people go into medicine for lots of reasons. A stable and generous paycheck is often a primary motivator. Or people have an underlying psychological makeup that motivates them - they want to be the best and be seen as the best in their community.
The external rewards are huge in medicine. It's not uncommon for parents to strongly encourage or even force their child on path towards becoming a physician. It’s also important to note that the reason for going into medicine may change as one progresses through their training. I realized that lifestyle was an important value I held. Not only was psychiatry clinically satisfying and in alignment with my strengths, but it could also afford me flexibility as well as the option of private practice and autonomy.
Before I got into medical school, I saw health and medicine through a holistic lens. Working as an apprentice on several organic farms and selling vegetables at the farmer's market, I saw the connection between soil health, human health, and the healing power of community. It was idealism in its purest form. I studied hard and had mentors who provided encouragement and gave me the confidence to apply to medical school. I wrote a poetic personal statement for admissions committees that reflected the interconnectedness that articulated my values and deeply held beliefs.
Not coming from a family of doctors or health professionals of any sort, I was hungry for more information about healing and health. I gravitated towards what was considered alternative or integrative medicine. I was curious about these healing professionals, whom I considered allies of physicians - part of a patient’s healing team with a primary goal of helping patients feel better. I conducted informational interviews with naturopaths, received acupuncture, and launched my own self-study about Chinese and ayurvedic medicine. For Christmas one year, I received David Rakel’s Integrative Medicine text and don’t remember ever feeling more excited about a Christmas gift.
It wasn’t until medical school that I realized that other medical students and physicians didn’t see naturopaths, chinese medicine practitioners, or acupuncturists as allies but often, as threats or quacks. I understood some of their concerns including the concern about practitioners practicing outside of their scope or practicing in dogmatic ways could actually cause harm to the patient. So I kept quiet in medical school about my clinical interests and continued to gravitate towards those in allopathic or conventional medicine who were more open-minded about other healing modalities. Attending the Academy for Integrative and Holistic Medicine (AIHM)’s Annual Conference during medical school was a deeply reaffirming experience - there were others who valued integrative medicine. We hugged each other, danced, and cherished these moments where we were in community with our tribe.
In medical school, I learned on my clinical rotations that the attending is the boss, the alpha - no questions asked. I witnessed attendings being condescending to patients and humiliating medical students (including myself). I saw the sheer exhaustion of medical residents and wondered how and if I could ever work as hard as they do. The realities of medical culture were crushing but as persistent as I was, I did what I was told and absorbed it all.
It wasn’t uncommon for attendings to treat anesthetized patients in the operating room with disrespect. Attendings would force us medical students to listen to their political views and we would be an outlet for them to vent about their burnout. On some rotations, attendings would quiz us and rank us according to our performance on the quiz they gave. Those who scored lowest were treated the poorest while those who scored highest were given more respect by the attending. Attendings would publicly humiliate you for not remembering a dose of a medication a patient was taking in front of the entire treatment team. I vividly remember a male surgery attending inappropriately touching my hip as I performed an outpatient mole removal procedure while the patient was laying down.
What keeps one from speaking out and trying to change the medical training culture? There are plenty of reasons. The power structure and hierarchy in medical training is, well, powerful. There is also the realization that your evaluation by the attending is required in order to advance in your training (so you can someday pay off your six-figure student loans) is what kept me from speaking up and out. These collective experiences left me unsure if I wanted to become a physician anymore. This isn’t what I thought it would be. I was lonely and confused. I ran long distances and won races, almost desperate for other ways - just any way that I could feel confident and competent in life.
Psychiatry residency is four years. It was a period of sleep deprivation and growth as well as a period of unlearning - unlearning the paternalistic way of practicing medicine that I learned while in medical school. I sought out mentors who not only constructively challenged me but modeled grace and compassion. I also started specifically seeking out female mentors.
In the fourth year of residency, there were opportunities in my program to complete elective rotations that weren’t required but were pursued based on clinical interests. As part of my fourth year electives, I completed a one-month integrative psychiatry rotation at the University of Arizona in Tucson, AZ. While there, I was fortunate to have outstanding role models who continue to guide me in spirit to this day and am forever in gratitude for their mentorship. The rotation was insightful, healing, and reaffirming.
I ate tacos and sat in on Wednesday lunchtime roundtable discussions with physical therapists, acupuncturists, naturopathic doctors, physicians, psychologists, craniosacral therapists, and Ayurvedic doctors. They were all literally at the table, discussing different treatment perspectives for a specific patient case. It was surreal and beautiful. I stumbled my way through leading a morning meditation and shadowed psychiatrists who worked tirelessly to practice holistically within the walls of an academic institution. It was also beautiful, despite the visible challenges of practicing slow medicine in our society’s fast medicine culture.
Throughout those four years of residency, I found my voice as I figured out what type of doctor I wanted to be and how to be an advocate. There has been so much more that I learned after graduating but perhaps one of the greatest lessons I learned during residency was that I possessed agency. I became really clear on what my values were and realized the immense fulfillment that could come from practicing medicine and living in a way that truly aligns with one’s values.
When I made the decision to leave my attending position from a large regional health care system, I was met with skepticism from several friends and colleagues in medicine. I started to feel like I was betraying medicine and my training. These friendships have faded and I sorted through my emotions. And for every challenge or cold shoulder that I experienced after leaving, there were twice as many supporters and allies.
Private practice allows me to build real human partnerships with organizations in my community and foster relationships with other healing professionals. I see less patients in order to provide more thoughtful care. I have time to read books and research articles related to my patient’s health. My patients don’t have to be affiliated with a certain health care system in order to see me. I don’t always get it right and I’ve made plenty of mistakes along this journey. I’m also aware that this way of practicing isn’t a solution to the broken health care system; however, it has been an easier way for both my patients and myself to work together, as humans. It is a way that reduces the influence of health insurance or bureaucracy - both of which can negatively impact care and the well-being of both the patient and physician.
In its purest form, the goal in medicine is to help others heal. This needs to be done through action and not just writing on billboards. And the only way we can accomplish this is through true partnership with our patients, communities, and other healing professionals.