What Motivates Doctors?

As a recently retired physician, I still maintain an interest in medical research, though I have to ask myself: Why? Surely not just from the point of view of a potential future patient. But not from the point of view of a practicing physician either. Perhaps I keep up just from a lifetime of habit?  Or is there something I miss about my old job?

These thoughts came to mind as I was reading some of the reports from the European Society of Cardiology meeting in Barcelona, Spain last week, in particular the results of the PARADIGM-HF trial in which a new, so far not brand-named drug, LCZ696, out-performed traditional ACE inhibition in patients with heart failure, and, in my own field of electrophysiology, the results of the STAR AF 2 study  which imply that a more limited is better than a more aggressive approach in ablation of persistent atrial fibrillation. I read these reports with a combination of excitement, my usual dose of skepticism, and perhaps a tinge of regret that, while the science of medicine advances inexorably, my own participation in this process ended as of December 31st, 2013, the day when I performed my last catheter ablation procedure for atrial fibrillation. Yes it seems odd that I was performing procedures one day and then retiring on the next, but that’s the way it was. At least I wasn’t on call my last night. And although I have written that doctors shouldn’t hesitate to retire when they are ready, sometimes I do look at my still-practicing colleagues with a bit of envy, feeling I am missing out on some of the fun of being a doctor.

Doctors just starting their medical careers, residents, fellows or newly appointed attendings, can easily get discouraged reading many of the online posts and comments from older doctors — including my own. There is a lot of negativity in these posts. We read about increasing work loads, decreasing salaries, competition from associated professionals, unmanageable electronic health record systems, terrible on-call nights, malpractice suits, loss of respect for the profession, Obamacare — the list goes on. It is probably tougher to be a doctor today than it ever has been. As my own career progressed, I had more and more of a feeling that I was swimming upstream against an opposing current of non-medical administrative, regulatory sewage. I found it easier to retire at a relatively early age (62) rather than continue the struggle. It wasn’t a brave decision, nor is it a practical decision for younger physicians, in particular those new physicians just out of medical school saddled with enormous debt. To those physicians, I would like to sound a note of optimism (which unfortunately might be drowned out in the comments section to this post).

Everyone who goes into medicine knows it is going to be hard. This was as true back when I started my internship as it is now. But there are rewards in medicine, and they still exist. I’m not talking about the traditional rewards of past years: financial success, stature in the community, pride in taking part in an old and honorable profession. Unfortunately much of this has evaporated in recent years. Nor am I talking about the occasional uplifting story whereby a patient heeds your exhortations to stop smoking and comes back years later to thank you for changing his life — as wonderful as such stories can be. No, I am talking about another aspect that is not frequently mentioned: the challenge of medicine.  Medicine is a battle against disease.  We doctors are on the front lines of this battle, and we are winning.

The challenge was there in every patient with atrial fibrillation, in every patient with ventricular tachycardia, in every patient with supraventricular tachycardia. These diagnoses were relevant to my field, but I’m sure that similar challenges exist in each specialty of medicine, and in general internal medicine as well. To me each diagnosis was a challenge, and the battle was fought using the weapons I had at hand: the ablation catheter, the pacemaker or implantable defibrillator, antiarrhythmic drugs, or simply persuasion, attempting to alter self-destructive life styles. It was immensely satisfying to ablate a pathway and control a life-threatening arrhythmia. But just as in the Wide Wide World of Sports, there was both the thrill of victory and the agony of defeat. Failures, especially complications, which, if you do enough procedures, statistically have to occur, always disproportionately tempered the successes, even though the latter were thankfully much more the norm. Such is human nature. But I think that which motivated me the most during my medical career was the wonderful adrenaline surge that came from ablating a tough atrial tachycardia or other arrhythmia. This is the sort of thing that motivates doctors despite all the other nonsense that we face. This is what keeps us going, or it least it was in my case.

And I sort of miss it.