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 Table of Contents  
STUDENT SECTION
Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 269-271

Why i chose to become a doctor


Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission12-Oct-2021
Date of Acceptance22-Oct-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Rachita Chopra
G-18, Lajpat Nagar III, New Delhi - 110 024
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_96_21

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How to cite this article:
Chopra R. Why i chose to become a doctor. J Med Evid 2021;2:269-71

How to cite this URL:
Chopra R. Why i chose to become a doctor. J Med Evid [serial online] 2021 [cited 2022 Aug 10];2:269-71. Available from: http://www.journaljme.org/text.asp?2021/2/3/269/333962



Sir,

On our morning rounds, often, besides patient care, our senior-most consultant asks for our thoughts on life and its many controversies. The most recent question, he posed to me, was on why I chose to become a doctor?

He approaches everything with keen interest, deep curiosity and a scientific mind. Once asked to jot down my thoughts, I was compelled to introspect, even when it was a question I had been asked many times

“I always wanted to be “A Doctor”, The question was why?”

Both my parents are doctors. However, they had never asked me to become one. More so, my father was always keen that I chose Indian Administrative Services.

I grew up inside and outside hospitals. They never felt like a morbid place. Tea time meant parents, then young doctors still early in their careers, discussing their day at work. Whenever my father would get an emergency call, it would mean 'A drive' for us. I was never scared of needles or going to 'the doctor'. In fact, white coats and scrubs triggered warmth. The joy and satisfaction my mother got from work was evident even then to me. I do not remember my 'Doctor Set', but have distinct memories of my father's tuning fork and hammer (Seeing the 'knee jerk', imitating it was exciting).

When I joined the medical college, everyone thought it was a straightforward choice for me.

But was it truly a choice or was it inevitable to want to be one considering my experiences growing up?

'Children pick up what they see, not what they are taught'

After the 10th board examinations, we were required to attend classes on subjects from all streams till the results were out. I was not really fond of zoology and botany that they were teaching during biology classes. Arts was interesting. I found psychology and journalism intriguing. My parents left it to me to take whatever subjects I wanted. My mother has always been the strongest believer of being 'the master of one's own life and the captain of one's own soul'. This fact, and having considered alternatives, reassures me, even today, however naïve then, there was intention and due consideration behind the decision.

According to self-determination theory, motivations on the spectrum range from motivation, externally regulated behaviour, introjected regulation of behaviour, regulation through identification, integrated regulation, to intrinsic motivation.[1] At best, I was intrinsically motivated; at worst regulated through identification.

“The Choice to become a surgeon was a lot more deliberate”.

I enjoyed reading physiology a lot more than anatomy, which felt like a lot of mugging. Till we started having surgery clinics. My favourite professor, when it comes to teaching, till date, was our then medicine head of the department, whose interactive discussions are unparalleled. However, there was no driving me away from surgery clinics. I was always there to present clinical cases. I was always staying extra to watch and assist surgeries. I do not think any of my friends from college would say that I wanted to be a surgeon just because my parents were surgeons. My passion and love for the subject was obvious. Moreover, the credit for that, I gave to my surgical clinical postings, surgery professors and residents at that time, and most of all getting to go to OT in every surgical branch and seeing as well as getting to scrub for cases. It was clear to me that 'This' is what I would love to do for the rest of my life. I can pinpoint the moment when I decided there is nothing else I would even consider (My ENT professor was making his postgraduate resident do hemithyroidectomy, skin to skin and I was standing right behind the resident in the theatre).

“I now realis, intrinsic and extrinsic motivation can co-exist”.

During college and internship, I grew a lot closer to my mom. I thoroughly enjoyed our discussions related to work and surgery. Our bond cemented even more once I had the honour to be able to choose to do my postgraduation under her, and the privilege to be able to come back to my home state and work and learn in a government medical college. I grew to respect her even more than I already did, and she is someone I actively now began to choose to emulate. I loved working. No one asked me to, but I was continuously at work. When I think back, there was so much joy in working, the fatigue never registered (Many times, I was suspected of sleeping in our daily morning classes, but when asked what was being discussed, I was always able to repeat. Only once was I truly caught). My outings were medical conferences. That would mean all work had to be completed before we left and rounds had to be taken again after the conference was over. The love, gratitude and respect I got from patients was deeply fulfilling. Some of them message and call till date. I was able to focus on surgery and tune out all else. It was like surgery was my life and the rest of my life work.

Atkinson's expectancy–value theory describes 'achievement task value' under four categories: attainment value (importance), intrinsic value (how much we enjoy the task), utility value (how useful the task is) and cost (whether what we're giving up to complete the task is worth sacrificing). Expectancy here refers to whether we expect that we would be successful in a task if we attempted it.[2] When one talks of importance, it directly correlates with the attachment to a sense of self. Putting my experience in context, motivations behind wanting to become a doctor completely aligned, especially when I grossly undervalued the cost.

“I knew what becoming a surgeon entailed, but it was after residency that I realised what it demanded”.

Every profession has evolved to help people and is meant 'to serve the society' in some form. However, this noble profession is first and foremost 'in service of society' that takes sincere, unending sacrifice and demands devotion. Every time a doctor deals with a patient, barring the exception of obstetrics, it is a hard and terrible time in someone's life. It requires tremendous grit, passion and persistence to spend day-in and day-out managing crisis after crisis in other people's life with empathy, as if it were routine. As a doctor, intellectual and social fulfilment that comes from being able to contribute in a meaningful way is in abundance. Working in health has the added benefit of seeing results immediately when compared to other domains such as policy, where results take much longer to manifest.

“A doctor's life is daily triage. And work is always red”.

These are things I took for a given having seen both my parents live that growing up. During my initial years of residency, I never begrudged the long and arduous working hours. I did not even register the festivals, birthdays, weddings and vacations I missed. I felt at home at work. I did not look for a life outside of work. I enjoyed work. I also truly believed that this is how it was to be.

“Health is a state of complete physical, mental and social wellbeing and not merely absence of disease”.

In his paper 'A theory of Human Motivation', Maslow described a hierarchy of human needs. He describes physiological and safety needs as basic needs, belongingness and love as well as esteem as psychological needs. Self-actualisation is the tip of the pyramid for self-fulfilment. He also coined the term 'meta motivation to describe the motivation of people who go beyond the scope of basic needs and strive for constant betterment.[3]

“As a doctor, one skips the base of the pyramid in pursuit of the rest”.

There are no meal times. As per the Indian Medical Association, over 80% of doctors are stressed out in their profession and nearly 56% do not sleep comfortably for even 7 h a day.[4] Healthcare workers are overworked and underpaid. The doctor–population ratio in India is 1:1404 against the WHO-prescribed ratio of 1:1000.[5] This is without accounting for the non-uniform distribution amongst states, rural and urban areas as well as private and public sectors. In comparing earnings with other countries, medical specialists potentially experience the greatest income disparities. Radiologists working in the UK and general surgeons operating in the USA can potentially earn more than double that of their counterparts working in India.[6] In a nationwide survey, the investigators noted a 45%–87% prevalence of burnout across domains of emotional exhaustion and personal accomplishment amongst medical practitioners in India.[7]

In the past years, it is harder to feel secure and safe at work with not just medico-legal cases rising, but also with instances of violence against doctors at work. A nationwide cross-sectional study from India conducted between November 2019 and April 2020 reported that 77.3% of doctors had faced workplace violence. According to US Bureau of Labour Statistics, workplace violence seen in healthcare workers is four times higher than all other workers.[8] A recent article published in the Indian Journal of Psychiatry quoted Indian Doctors to be at 2.5 times' risk of suicide than the general population and reported 30 suicides amongst doctors in 3 years (2016-2019). Majority were younger than 40 years.[9]

Besides organisational factors such as negative leadership behaviours, excessive workloads, insufficient rewards, limited interpersonal collaboration and limited opportunities for advancement, it has been found that personal factors such as self-critical behaviours, engaging in unhelpful coping strategies, sleep deprivation, over-commitment, perfectionism, idealism and work-life imbalance and an inadequate support system outside the work environment are also known to lead to burnout.[10]

“I took a break to prepare for sub-specialisation in GI surgery”.

Being away from work was the hardest, darkest time in my life. The virtue that arose from this necessity was my interest in public policy and rekindling my interest in co-curriculars. I was suddenly healthy, exercising, dancing, learning an instrument, being present for family and friends. I pursued a multitude of online courses whether on global health, humanitarian crisis or upgrading my skills and knowledge related to surgery. I did a brief course in public policy where I got to interact with stalwarts in the field as well as collaborate and work with people pursuing a plethora of professions. It reset my expectations of working environment. I had heard of meditating and introspecting at peaks of mountains shrouded in serenity, but my epiphanies came curled on a bed next to a laptop. Even though I was questioning everything, I was reading my subject, and bit by bit, rebuilding.

“Once I rejoined work, quickly, all was forgotten”.

I was once again immersed, morning to morning, in the daily routine of which none was routine. I was roaming corridors of a remarkable institution on rounds with the person who birthed the sub-speciality I pursued. He quoted something that captured the ethos of how I was raised, yet, raised a debate in my mind, though I was in complete agreement. 'Farmer's feet are the best manure'. My being a surgeon is so closely tied to my identity, I find Residency in surgery equipped me for life, instead of the other way around. Strategic rest breaks in life, do just as good as ones in surgery.

'All work and no play make Jane a dull girl'.

Ikigai, described as a reason to jump out of bed every morning, exists at the intersection of what we love, what we are good at, what the world needs and what we can be paid for.[11] In the operation theatres, most surgeons achieve 'Flow', the kind of joy one gets from playing an instrument or sculpting.

This monologue bottles down to the cliché of work–life balance and making the tough choices and trade-offs. Filtering what matters most and not judging oneself for our own choices. Not making the choices in fear or compulsion. A choice, coming from a place of strength and clarity, only, can be the truth.

“Would I still choose to be a doctor”?

Most certainly, yes.

Acknowledgements

I would like to express my sincere gratitude to Professor Samiran Nundy, for prompting the question 'Why I Chose To Become A Doctor' compelling me to write this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. Plos one 2020;15:e0239193.  Back to cited text no. 1
    
2.
Drew C. Expectancy Value Theory. Available from: https://helpfulprofessor.com/expectancy-value-theory/. [Last accessed on 2021 Oct 12].  Back to cited text no. 2
    
3.
Wikipedia. Maslow's Hierarchy of Needs. Available from: https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs. [Last accessed on 2021 Oct 12].  Back to cited text no. 3
    
4.
Perapaddan BS. Majority of Doctors in India Fear Violence, Says IMA Survey. Available from: https://www.thehindu.com/sci-tech/health/majority-of-doctors-in-india-fear-violence-says-ima-survey/article19198919.ece. [Last accessed on 2021 Oct 12].  Back to cited text no. 4
    
5.
IndiaSpend. India's Shortage of Doctors, Nurses may Hamper COVID19 Response. Available from: https://www.indiaspend.com/indias-shortage-of-doctors-nurses-may-hamper-covid19-response/. [Last accessed on 2021 Oct 12].  Back to cited text no. 5
    
6.
George G, Rhodes B. Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries. Hum Resour Health 2017;15:74.  Back to cited text no. 6
    
7.
Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS, Wankhade K, et al. Burnout syndrome among medical practitioners across India: A questionnaire-based survey. Cureus 2016;8:e771.  Back to cited text no. 7
    
8.
Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. PLoS One 2020;15:e0239193.  Back to cited text no. 8
    
9.
Kishor M, Chandran S, Vinay HR, Ram D. Suicide among Indian doctors. Indian J Psychiatry 2021;63:279-84.  Back to cited text no. 9
  [Full text]  
10.
Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: A review. Behav Sci (Basel) 2018;8:98.  Back to cited text no. 10
    
11.
García H, Miralles F, Cleary H, García H. Ikigai: The Japanese Secret to a Long and Happy Life. New York: Penguin Books; 2017.  Back to cited text no. 11
    




 

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