I made a really good medical decision the other day. I can't go into details of course, although some day it may end up anonymized and folded into a story, but it felt good (for me and the patient). It involved using several different layers of knowledge to come up with a solution, a bit like solving the Friday NYT crossword puzzle: not impossible, but difficult enough to be fun (when I say "difficult" about the crossword, I speak for myself, not my genius brother-in-law who could solve it blindfolded, upside-down, and drunk).
Medicine is full of puzzles, most of which aren't particularly good for the patient. It's much better to be a boring patient than an interesting one. There are no truly "boring" patients of course. When someone relatively healthy comes in, I get to learn about the work they do, often something I've never heard of. I hear unique family tales, tragedies and triumphs; this is one of the joys of medicine, being allowed to hear other peoples stories. I never consider the time wasted.
I recently spent twenty minutes with a patient discussing recipes. Not only did I learn a few tips, but I also learned about how this particular hypertensive patient prepares and eats his meals. And I made a friend. Medicine involves a lot of salesmanship. I have to talk people into doing some fairly unpleasant things, so being on friendly terms with them helps grease the, er, wheels.
In past posts, there have been debates as to whether medicine is "special": is it a job like any other, or is it more of an identity? I favor the latter in many situations. Sure, being someone's banker involves a level of trust and intimacy, a sharing of private knowledge, but medicine takes it a stop further. Just a few moments ago (while I was typing paragraph three) a heard screaming form the other end of the cafe. A barrista had just spilled a pitcher of boiling water on herself. I invited myself into the back to tend to her. This was possible only because our gives a special trusted status to physicians (warranted or not). Once I announced I was a doctor and I was willing to help, there was no argument, no fear, just a look of relief. I left the office before five today, but I never truly leave the job.
The puzzles, the identity, the stories, the relationships all make medicine unique and enjoyable. Whatever the instability in the business of medicine, I can never leave the job, because I am the job, and the job is me.