Physician, Know Thyself: A Self-Identity Crisis

Financial Planning for Doctors

Lawrence B. KellerDuring my third year of medical school I received a harrowing phone call, “Can you please go over to Steve’s place? I am worried about him. He might want to hurt himself.” The person requesting this was the mother of Steve, one of my best friends in medical school. At the time, I was a third year medical student on my surgical rotation. Steve’s mom was concerned he might commit suicide.

Sleep deprived as I was, I ventured over to Steve’s apartment. This is where I would learn the true meaning of the command: “Physician, Know Thyself.”

In the Beginning

Steve and I met during my first year of medical school.

It was his second first year as he took a break during what should have been his first year after some tough family situations. His parent’s family pharmacy was failing at home.

Due to his family’s struggles, Steve made an intentional decision to take a break from medical school to help his family business. He would be coming back to medical school the next year to start over once his family life was in order. His repeat attempt is when I met him.

This sounded all well and good, except that Steve’s next attempt at medical school encountered problems, too. He didn’t pass a class, which led to a formal process where Steve would have to fight for the right to stay in medical school. While battling major anxiety, Steve underwent several committee meetings, multiple appeals, and many sleepless nights.

Steve had been engaged that year. He was marrying his high school sweetheart of more than ten years. He found out that his dream of becoming a physician would end the day before his wedding day.

As I watched his soon-to-be wife walk down the aisle on their wedding day, the skies opened up and it began to rain. As a groomsman in his wedding, I couldn’t help but feel this was a harbinger for what was to come.

On the day he and his wife said, “I do,” he was surrounded by his medical school friends all who (except for me) had no idea that their journey would continue while Steve would be left behind.

A Downward Identity Spiral

It didn’t take long after that for Steve’s downward spiral to begin. He had always dreamed of becoming a family practice doctor in his hometown. With a lot of hard work and perseverance, he received admission to medical school.

Yet, he delayed going to medical school the first time for a year while his older sister applied to medical school. Steve felt bad that he would go to medical school before his older sister. He was a caring and selfless person who enjoyed putting others first.

Unfortunately, because of the amount of work he put into getting into medical school and the long-held dream he had of becoming a doctor, Steve’s identity began to be rooted in that dream. When it all fell apart, his relationship with his wife began to unravel.

He spiraled into a deep and dark depression. His marriage never really stood a chance given the circumstances in which it started. Divorced and depressed, he went to a particularly dark place.

What determines your identity?

Steve’s story has impacted me profoundly, including how I think about my self-identity.

What is your self-identity? You can find out by imagining the following scenario: Imagine that you had to explain to someone you have never met, but who was very interested in learning about you, who you are.  What would you say if they asked you to tell them about yourself?

Alternatively, you could ask yourself the following “What are the most important things in your life that if you lost would change who you are?

A Doctor’s Self Identity

When answering that first question, most physicians would start out by saying something like the following:

Well, I am a doctor who works at the local hospital. I am originally from California, but did my training here on the east coast. I’ve been married for five years. We have two kids, a boy who is four and a girl who is two. I love playing sports, particularly basketball. And I really enjoy cooking. What else do you want to know?

On the surface, this all seems like a perfectly acceptable response. Except for one major thing. We have labored so long to achieve the right to call ourselves “doctor” that it has become part of our identity.

You know what I am talking about. That moment someone asks what you do and you are proud to say, “Well, I am a doctor.” Or maybe it’s when you notice how proud your spouse, parents, children, or anyone else you love is when they explain that you are a doctor.

This is not, in and of itself, a bad thing. Obviously, it is a wonderful thing for medicine to be a calling and a profession.  However, it is also something of which we must be mindful.  We would not cease to exist if this title went away.  Being a physician should not define us.

In the second question above about what would change your identity if you lost it, was your profession one of the answers? How does that make you feel? If you left it out, are you being honest?

Fight for your self-identity

Steve lost his identity the day he found out medical school was over. It wrecked his marriage. It tormented his mental health. And it even led his mother to call me that night out of fear that he would take his life.

Please, take some time to inventory what matters most to you in life. If you aren’t sure how to do this, I encourage you to go through the Three Kinder Questions to help you sort it out.  It’s not only good for financial and life planning, but for figuring out your priorities.

This has to be done before it all comes crashing down.  Love your job.  Be passionate about it.  And be a really good doctor.  But don’t let it define you.

Otherwise, you might be left to pick up the pieces of your dismantled life.

Being a doctor is a good thing, but “like money it is not the end all, be all.” You must root yourselves in things of substance. Not in idols that will forget you the moment that you least expect it.  We know that the hospital won’t love us back.  Therefore, we must not lose our identity within its walls.

Physician, do you know thyself?

I hope this post made you contemplate some important aspects of your life. Do you have examples like Steve’s from your experience? Are you like Steve yourself? How do we combat these things? Leave a comment below.

TPP

42 thoughts on “Physician, Know Thyself: A Self-Identity Crisis”

  1. Medical School can be crushing. Developing a healthy life outside of work is the best protection we have. This is an important lesson for anyone who works at a job as all enclosing as ours!

  2. I’ve known quite a few doctors and while it is easy in America to lose your identity in your profession, it seems like it is easier still for doctors. Not having been through the experience myself, I can only speculate that the all consuming work required to achieve this goal (even just to get into medical school) may have something to do with that. Great message for all of us!

  3. I am not a doctor, but I have had a few people in my extended circle commit suicide. I know the damage it causes in those that survive. I think that is the worst thing you could do to the people you love. A friend’s husband just committed suicide last week, and I am still in shock.

    I also understand the part where your identity is tied to what you do for a living. It is sad that it happens far more than what it should be.

    • Hey Busy Mom, I am sorry to hear about your friend’s husband. Unfortunately, most of the time, suicide survivors say that they do it because they feel like a burden to their family and friends. While we all recognize this isn’t true, it’s hard to reason with a person who is mentally ill. Logical reasoning may not be happening.

      Suicide is devestating. It’s hit my family, too. And I’ve obviously had close friends who were on the brink.

      It’s a big and silent problem in the medical community where people fail to discuss it. When a physician commits suicide the fact that it was a suicide rarely comes out. Particularly in resident physicians.

      It’s a battle worth fighting, and recoginzing the problem is the first step.

      Thanks for your comment.

  4. I’m often helping to expunge records of people who were involuntarily committed wrongfully. (Doctors hate this guy!) There’s a common theme that emerges in many client stories that taught me something about how involuntary commitments work in practice: Often, it’s a fleeting, one-moment issue caused by unusual life circumstances that mirror your Steve story. Sometimes, the person doesn’t really exhibit “committable” conduct, but the physician will commit him or her anyway out of an abundance of caution because sometimes you can just…tell, when a person is in a dark place, that they need help. And sometimes a temporary mental health problem comes out of nowhere, and fades away never to return. It’s such an odd and hard-to-define area, and I imagine a very tough one for doctors who wield that very powerful tool that affect people’s rights forever, sometimes in unpredictable ways.

    Thanks for the post and reminder that it is really important to keep perspective and a sense of self separate from any one person or thing in your life.

  5. For most people, their job is their identity. Especially for men, where there is a rooted mentality of ‘what you do is who you are’. Their self-worth is interwoven with their day-to-day job. I know this is generalizing.
    For physicians, their training is so narrow in scope that if their M.D. title was taken away, they couldn’t do much else. So it’s important to have many interests and wear many hats and elevate the importance of those titles. Parent, spouse, investor, small business owner, real estate entrepreneur, school volunteer, church elder, teacher, coach, blogger, friend, sibling, etc. These are all examples of things that make one’s self worth, not just M.D. Great post.

    • I whole heartedly agree. It is so important to stay connected to things outside of medicine. It maintains your roots in other things outside of medicine and often serves as a mental break from our family lives in hospitals and clinics.

      We need to have lives outside of medicine for so many reasons.

  6. This identity issue especially tends to come up in professions that require years of training to get into. When you asked about how we identify ourselves, one of the things I thought about was being a lawyer. How do you stop seeing your profession as a major part of your identity when you spent so much time getting into it and spend so much time doing it? It’s definitely hard to separate yourself and something I’m working on.

    Thanks very much for this post. It’s so important to keep things in perspective and to be mindful of others around us who may be struggling. I’m glad to hear that your friend is better and didn’t succumb to his negative feelings.

    • Thanks for the comment.

      It really is a tough thing to separate our job from our identity, particularly for those of us that spent so long obtaining the goal. I try to remember that I am so many other things. I am a husband. I am a father. I am a brother. A son. I am sinner undeserving of Grace. I am a lot of things that are more important than being a doctor. I try to remember that daily when work tries to pry me away from other things that are more important.

  7. Thought provoking post. A friend of mine from residency committed suicide. A friend of mine from my first practice’s daughter committed suicide. I guess we all knew someone. I don’t think it is possible to be doctor without some degree of self identity. We need to diversify our selves just like our portfolios. I have friends who are not doctors and this helps.

    • Agreed. Having identity in other things outside of medicine is important. It probably isn’t possible to remove your entire identity from medicine, but we can remove most of it. I am many things that are more important to me than being a doctor.

  8. Identity and ego are topics close to my heart, and I think they are an underappreciated cause for physician suicide and depression/substance abuse/etc. When we become something instead of doing something it is devastating to our ego. Instead of failing at doing something we become a failure. I wish your friend Steve all the best.

    • I completely agree, HP.

      I’ve never thought about it quite how you put it there… How we become the failure if we wrap our self identity in what we are doing instead of who we are. Who we are should be independent of whether what we are doing fails. That’s a great way to think about it. Thanks!

  9. Intense story. I’ve read plenty on physician identity. This one will stick.

    I’ve been “weaning” myself from the MD identity. This has been made possible becuase I’m a father of 2 and also I’m through the learning curve of post residency work and have time to pursue other interests. Also, being financially independent has helped liberate me from the need to be a doctor.

    Philosophically and psychologically I could post a few thousand words why/how/ethics. Ultimately though, it just happened slowly and I’m ok letting it go as my family and I pivot to what’s next, medicine optional.

    • That’s great! I think making sure you know who you are and how you got to where you are is vitally important. Unfortunately, there are too many of our friends and colleagues that learn this the hard way.

      At the end of the day, I can think of so many things that are more important to me than being a physician, but I’d be lying if I said that I was not really proud when someone realizes I am a physician. As said above, likely not a bad thing in and of itself, but probably not a great thing either.

      We are all just humans trying to figure out this thing called life. Best to make sure that we identify ourselves with the people and things that truly are important to us. Being a husband and dad of three has helped me a lot there, too.

  10. I failed out of med school. I was simply just too dumb to handle the work. All of my coursework was a C (aside from the classes I failed) and I was usually 10 points below the class average.

    I am extremely ashamed of myself and lament all the hard work and time wasted.

    The worst part is that I am now a nurse, so every single day I work with doctors who were able to succeed where I failed.

    Every night is spent alone in the dark, depressed, crying, ruminating on the failure I became and the life I ruined.

    I try to put on a happy face and do my best at work, but on the inside I am completely empty and hollow. The sadness I feel is constant and I cannot seem to find any light in the world.

    I loathe myself.

  11. Great post. I should post about my brother who went through the same type of crisis. Not as a doctor but trying to find his path. He was one year younger than I and committed suicide. I think about him almost daily what he could have become.

  12. On Failed’s post. While I certainly understand how he feels, he should be proud to be a nurse. I admire all physicians because I know what it takes and the sacrifice to become one.

    My daughter is an RN, and that took a lot of work too. You can make good money as a nurse and help a lot of people. Be proud of that fact.

    I am an Accountant. My father was an Engineer. He used to say those who couldn’t last in Engineering went to Accounting, those who couldn’t do Accounting ended up in Marketing.

    Being an RN is an admirable profession, be proud of that fact.

  13. Thank you TPP for your blog and such insightful and thought provoking posts. This has given me wonderful food for thought this fine Sunday morning during my high thinking time of the day. You have prompted me to come up with a working response of who I am:

    “I am a curious explorer, temporarily of the mostly armchair variety, but on a path to more mobility. I am a loving father of a blooming college student, and am extremely proud of the time and presence I provided her over the last 20 years. I have about two years left until my financial independence, in a job that binds me in a tunnel of mediocrity, though I’ve found local passions to help me see the light at the end. Oh, and I’m a NASA engineer who really wants to help save people’s lives rather than our mission of intentionally putting them in harms way. “

  14. Failed DO: As a nurse you are the deliverer of health care. I was a Dr. for 35 yrs. but never deluded myself that I could do anything without nurses and the other members of the care team. Without you there would be little to no healthcare. A Dr. makes some of the decisions but nurses always have input and the true healing in medicine comes at the hands of the nurses. Don’t ever forget that. Thanks for your service.

  15. Very thought provoking post. Separating profession and self-identity is difficult after going through all the training to get to being a physician. I understand the underlying message in this post about figuring out your own identity outside of medicine, so that if you lost that aspect of your life, you would not fall apart like Steve did.

    That being said, I don’t find it wrong to have part of your profession define part of your identity. For example:

    “I am an adventurer, lover of life and food, and a family man. I am also a life long learner, and find passion in making a positive impact in the world through healing others, clinical research, and being a physician leader.”

    I’d say even if I reach FI, I would not leave medicine and being a physician would not leave my self-identity.

    • Your answer is not so different than mine. I don’t mind the aspect of being a physician as part of the definition. I do mind it when it is the leading thing we mention (which implies it is most important).

      I normally tell people that I am a God-fearing husband and father of three. I am an avid Wake Forest sports fan, craft beer snob, and “used to be” home Brewer. I also happen to be a physician anesthesiologist and physician finance blogger.

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