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Making the decision each day to stay in medicine

For as long as I can remember, I have wanted to be a doctor. I played hospital with my dolls as a child. I never thought of alternative career paths. I climbed the long (and sometimes unbearably steep) mountain to reach the top.


The career path to clinical medicine can sometimes feel like climbing a mountain. A snow-capped mountain in hues of blue and grey
The career path to clinical medicine can sometimes feel like climbing a mountain. (Credit: Unsplash)

I loved clinical medicine for many years. Most days I still do. Until recently, I had never considered leaving, choosing a different path. Then, I walked into clinic and found out a patient of mine had a bad outcome. As I reviewed the chart looking for anything I could have done differently, a switch flipped.


I was done.

I was done practicing clinical medicine.

I felt the system had let my patient down. Had let me down.

I have been an oncologist for over 15 years. I am not new to death or dying. I take care of very sick patients. I give very high-risk treatments. What was different today? I have seen many adverse outcomes. I had never had this reaction before. I had never before said to myself, let alone others, that I was done. It was a visceral feeling: time to retire from clinical medicine.


Enough with life-or-death decisions. I was just done.


I felt sure of my decision. So sure, I was concerned. What had happened?


Was this burnout? I truly did not believe so. I had experienced burnout about 9 months prior. I had hired a physician coach. I took a serious look at what I needed in my life to keep my batteries charged. I felt I had made lots of progress. I am no longer a people-pleaser. I learned fierce boundaries. I obtained my coaching certification with the goal of helping other physicians going through what I had experienced. I felt like I was in a good place. I was managing my mind. I had a toolbox full of tools. I was going to weather the healthcare storm. I was not going to be another statistic of the Great Resignation.


Yet here I was. What had happened? The tools were no longer enough.


I refused to quit and become another statistic. I wasn't like 'the others'. A yellow post-it note saying "I Quit!" is taped to a laptop keyboard.
I refused to quit and become another statistic. I wasn't like 'the others'. (Credit: Unsplash)

I was mad. I was shocked. I was confused. Most of all, I was disappointed. Profoundly disappointed.


I consulted close friends, my physician coach, other coaches, colleagues, looking for an answer.


What had changed? The term 'moral injury' was thrown out.

Hmmm? I was referred to an editorial entitled; Reframing Clinician Distress: Moral Injury Not Burnout . In this editorial, moral injury was described as 'the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.'


Bingo!

I was experiencing moral injury. I did not have a tool in my toolbox to deal with moral injury. It had been months of experiencing moral injury on different levels. Insurance companies, staff shortages, bed shortages, IV contrast shortages, EMR changes. The list went on and on. This was the proverbial straw that broke the camel's back.


Then it dawned on me. It was a boundary. I was coming from a place of empowerment. The

very same tools I had learned recovering from burnout were now leading me to question

whether I was willing to continue to deal with moral injury. I realized I had the ability to choose to stay or go.


This was not a decision to make lightly. I needed to be sure, I was sure. I made myself a deal.

I made a chart, much like you make for a toddler. Each day if I did not lose my $#*%, walk out, quit, and did my best to take care of the patients, I got a sticker. Enough stickers, I got to buy myself a reward. Hey, I needed to do what I needed to do.


I wanted to stay but my heart, my gut, said to go. The following week in clinic when another

situation beyond my control occurred, I asked myself, “How does leaving help the patients?”


Ow. Punch in the gut.


As a doctor, I have always been taught that the buck stops with me. This is no longer true. A stethoscope on a white background
As a doctor, I have always been taught that the buck stops with me. This is no longer true. (Credit: Unsplash)

As a physician, I have always been taught that the buck stops with me. I had to realize that this is no longer true. The problems are bigger than I am. I do not have the power or the resources to fix a broken system. If I want to stay in clinical medicine, I must learn to work within the broken system.


All I can do each day is my best. I just hope my best is good enough.


I have chosen to stay. But I will stay empowered. I realize it is my decision. Right now, I grieve the fact that each day I have to make the decision to stay. To stay in what was once a dream of mine. Healthcare is no longer what it once was. Where are we heading? What is the future?


For today, I am celebrating that I once again made the decision to stay. Another sticker.

Hopefully one day I will no longer need that chart.


1.) Dean et al. Fed Pract. 2019 Sep;36(9):400-402


This writing was originally published on KevinMD on July 1st, 2022.

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