When leaving medicine is the best medicine

Why does a doctor hang up her stethoscope and quit?

I don’t mean a doctor who reaches their 60s or 70s and wants to retire. I mean a doctor in her 30s, who not long ago spent countless hours and uncountable sums of money learning her craft. One with a long and potentially bright career ahead.

This question is on my mind because my hem/onc has decided to quit her practice as of the end of May. She doesn’t exactly say why in her letter to her patients, but her office staff provides a little more information: She wants to “go in a new direction in her life.” She “may do some traveling.”

“Doing some traveling” is sometimes a catchphrase for “finding yourself.” I never got the impression that my doctor -- we'll call her Dr. Chopin -- was particularly unhappy with her work. Not that we discussed her situation too much when I visited. She was usually focused on palpating my lymph nodes, knocking on my rib cage to check the liver, and having me breathe deeply so she could go in search of my spleen.

“I can feel a spleen tip,” she would say more often than not. Sometimes we would discuss treatment options, and we once had a long discussion of what we CLL patients talk about all the time: If I use therapy X, am I burning bridges, so how do I control the disease incrementally, as it were. At the end she termed this an “esoteric” discussion, which surprised me, because it was composed of the down-to-earth considerations that patients deal with.

But I liked her general manner, which was businesslike in an easygoing, friendly sort of way. She hid nothing from us (for Marilyn was always there with me) and we felt comfortable being honest with her. If we disagreed about a treatment, we agreed to disagree. I have a feeling that, had she been our neighbor and not our doctor, we might have been gotten along pretty well.

She did let slip an occasional frustration. Once she complained about a health insurance company reviewing her and finding that she had “prescribed too much.” As I recall, she said, “Either the patient needs the drug or they don’t.” Another time she spent much of our appointment talking about the frustrations of dealing with some patients, probably the ones we had seen as we passed by the open door of the examination room next to us. They looked frozen, blank, in shock. There was only so much a doctor can do, Dr. Chopin told us. A doctor cannot make happen what nature has decided cannot happen. Another time, perhaps a year ago, when she may have started entertaining thoughts of leaving her profession, she mentioned that she had seen a movie she liked called “What the BLEEP Do We Know?” It’s a New Agey picture about the meaning of life, and Dr. Chopin declaimed briefly about life's mysteries. Most recently, our always-busy doctor pointed out that she had done the unheard of on a Saturday -- slept in until 11 a.m.

In her bedside manner, Dr. Chopin was not the touchy-feely type. But perhaps she was, inside, and just wasn’t able to let it out -- until now. There must be great frustrations as well as great rewards in hematology/oncology. One saves lives, and one also sees them lost. Dr. Chopin had a lot of breast cancer patients, women her own age, some of whom met their ends well before their time.

Perhaps this left an impression of life’s shortness, and perhaps being in the trenches for six years or so left my doctor with the feeling that there was something else she could be doing, something less consuming and more personally fulfilling. (I do know she is not married and does not have family obligations, which can sometimes lead to career changes and reassessments.)

I cannot really complain -- well, yes I can, because I know it won’t be easy to find a doctor with whom I will get along as well -- but I once did something similar. I gave up a promising journalism career in my 30s when it became apparent that I was going to end up as an editor for the rest of my life. Reporters are a dime a dozen but editors are hard to come by. Still, I knew I had the soul of a writer. Writers act and editors largely react (and being city editor of a newspaper is like herding cats of varying levels of competence.) I remember looking down the long road one day, wondering how it would end. It would have ended in a position of some importance at a newspaper we’ve all heard of, and this would have impressed my family and friends. But my heart sank whenever I thought of it.

Dr. Chopin was just named a “Top Doctor” by Phoenix magazine, an annual event in which doctors vote for their best colleagues. So I suppose it can be argued that she is quitting at the top of her game. I hope we are losing her because her heart brightens at the thought of doing something else, and not because the grind of her work is making her want to scream and run away.

I will miss the sound of her clompy black shoes as she approaches the examination room and pulls my file from the plastic holder on the outside of the door. That task will fall to someone else now. I wish Dr. Chopin luck, and I wish it for myself, too.

P.S.

There was a hilarious abstract on PubMed from Harvard Medical School called "Leaving medicine: the consequences of physician dissatisfaction." The conclusion? "Our findings demonstrate that dissatisfied physicians were 2 to 3 times more likely to leave medicine than satisfied physicians." I wonder how much money it took to figure that one out.