This unusual question prompted some personal reflection, so I decided to blog this one

Q: I understand that you may or may not be able to help me, but I thought that it would be well worth the shot. I am trying to decide if pursuing a career in medicine is for me. When it comes down to it, I have never wanted anything else. As to what kind of doctor I want to be is what brings me to you. How did you decide? When did you figure it out? I have a degree in psychology concentrating in behavioral neuroscience but I am not convinced that I want to continue with it. I am trying to get a feel for the everyday lives in various specialties. Reading statistics in book doesn’t tell me whether I’ll have time to raise a family for example. I would like to know what the average work week is like such as the number of hours and number of patients I would expect to see. How much time do I have to spend with patients? Is there a place that I can find all of this out? Thank you for your time.

Dr. Joshua’s Thoughts

In my view, the biggest decision is whether to go into medicine or not. Choosing your specialty comes later, and is a secondary consideration. As you advance in your studies, you will start to get an idea of what sort of doctor you’d like to be. After the first pathology autopsies you’ll certainly have an idea of what it would be like to pursue a career in pathology - a lot of cadavers and even more of staring into the microscope. After the labor and delivery course you’ll have an idea what it’s like to deliver babies for a living. Then again, after medical school you may still be unsure of what you want to do, and some end up trying several fields before finding their trade.

Medicine is a demanding and sometimes unforgiving career. If you end up a surgery resident, you’ll have some tough times for years after medical school, and little time for anything else. Also, you are never quite off-duty. Long after the working day is over, you’ll find yourself reviewing the day’s cases in your head. The burden of responsibility is great. Also, you will never again look at people the way you used to - you’re always subconsciously diagnosing everyone. Sounds crazy, but it’s true. Also, your friends and relatives will always see you as an opportunity to unload their health problems. Medicine will become a major part of your identity. So you really have to want it - it’s a lifetime commitment.

On the other hand, medicine is a wonderful career because after you graduate, you’ll have a world of opportunities. As a medical doctor, you can pursue a career in a wide variety of fields, such as basic science, clinical science, neuroscience, administration, teaching, public health, clinical chemistry, clinical physiology, radiology, internal medicine, and, of course, if you like to work with your hands, surgery.

How did I become a neurosurgeon, then? It was probably a combination of - and I say this in all modesty - fabulous piece of ingenious quick-thinking, agility, fancy footwork and self-sacrifice*. I enrolled in an MD/PhD program in medical school, and finished my Ph.D. in neuroscience. I was always intrigued by the workings of the brain, and after finishing my clinical studies, I wanted to try neurology and psychiatry, and when by a fortunate coincidence the opportunity arose, I decided to try my hand at neurosurgery, and I never looked back. Neurosurgery is a wonderful combination of neuroscience, clinical neurology, and craftsmanship.

There are times when I wish I’d never become a doctor. I’ve spent practically all of my adult life surrounded by illness, pain and suffering. Sometimes it’s just too much, and that’s when I get really existential, I want to forget about it all and make all my medical knowledge disappear so I could look at life from a completely non-medical point of view. But the path is chosen, and there’s no going back for me. Fortunately, these moments pass, and when it comes down to it, there is really no other job I’d rather be doing than practicing medicine.

*This is of course what Ford Prefect would have said. For me, I guess it was just one of those things.