Personal and Professional Transformation: What the Process Looks Like for Doctors. An Example.
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In October, I had an extraordinary experience helping a surgeon friend craft an application for a new academic opportunity. I’m sharing the story because it illustrates so clearly some of the problems we doctors face when we have achieved mastery in our specialty yet still sense that the conventional path isn’t cutting it for us, when we have to take matters in hand and chart a course correction or even an entirely new course. We might feel (or hear) that we aren’t a good fit in our style of practice, specialty, or institution. We might discredit as naive the desire that led us to this path and find that our dream has become a dry husk of what it was. We might be clear-sighted about the problems of medicine and want to make changes but feel overwhelmed and under-resourced or even greedy for imagining it. Twice in the last week, I’ve heard “It’s not possible to pour from an empty cup.”
When a doctor starts to figure out how to fill her empty cup, that’s the beginning of carving out a more personalized practice path.
Fear of losing everything too often keeps us on a predictable but ultimately stagnant, depleting track, never daring to fill the cup.
Several years ago, when my friend Pringl Miller, MD was already a seasoned surgeon, she came to a crossroads like this, and she chose the bumpy ride to reach for higher ground. She asked a capable academic surgeon colleague for help, and she got it. This helped consolidate her confidence and vision; her admirable plan began to take shape. She wanted black-belt communication skills, a better framework for perceiving and addressing inequities experienced by patients and colleagues at the individual and organizational levels, more intellectual and collaborative work relationships, and better tools for navigating the challenging moral landscape of clinical practice. She shook up her life to complete two fellowships: Hospice and Palliative Medicine and Clinical Medical Ethics. Along the way, she also founded the amazing 501c3 organization Physician Just Equity which offers peer support to and champions balanced resolutions for physicians who have experienced workplace injustices. She also co-founded the Surgical Palliative Care Society. She has done contract acute care surgery work while she planned her transition and then during her fellowships and search for the right job.
Her goal at the outset was to fuse her clinical surgical practice, award-winning teaching skills, and the perspective and practical applications of her fellowship training in a forward-thinking academic role. The complementarity and value of this mash-up is so obvious to her that it came as a complete surprise when prospective employers had a hard time seeing the synergy of this combo. As I first read drafts of her CV, cover letter, and diversity and teaching statements, I appreciated how much she has achieved yet also could sense an uneasiness about how to bring these rarely integrated skills into focus for surgical leadership. The expectations of conformity and consistency are strong in surgery but perhaps nowhere more than in academics where practice standards are promulgated. Likewise, she had to adapt her surgical activity first to accommodate fellowship demands and then during her job search. These were strategic but nonetheless stretched the boundaries of conventional practice in a second dimension, and she hadn't yet found her home base for practice in the new configuration.
Losing the thread.
I recognize that uneasiness as something I hear from almost every physician I work with who is on a distinctive path, one they may not yet recognize themselves. I, too, have felt this. Ten years ago, as it was dawning on me that I needed to practice medicine in ways and places that support my well-being rather than undermining it—that all of us need to thrive because of how we practice, not despite it—and that even though we occasionally inevitably will feel helpless facing the circumstances of our patients, we should never feel helpless in the systems that depend on our skills and devotion, I had only hazy ideas about how I could help bring about such consciousness and change or even how to rationalize it. I had so many questions and so few answers. Such uneasiness can bloom into full-on, paralyzing, demeaning self-doubt. Not only can it be treacherous to step off the beaten path (especially if we are critical of the healthcare system) and perplexing to others, we physicians habitually see our needs or challenges as failures: everyone else seems to be adjusting to how things are, so why can’t we? This frame of mind is stifling. It leaves virtually no space to discover and nurture a nascent, possibly innovative idea that is trying to be born through us. Even when we have a truly strong inner voice guiding our vision, our confidence can be thrashed. We can become disoriented. We can actually lose the thread of our own story.
As I sifted through Pringl's application full of rich detail, it still felt to me like a collage that asked a lot of the reader. Then after nearly a full day of sitting with it and rearranging parts of it, a throughline came as if out of the mists: Intersectionality. Her throughline is intersectionality; it is her coherence. For me as a reader, all the parts seemed to fall into place around this idea. At the very least, it provided a context for receiving the
Finding our throughline
elements of her journey. Pringl lives intersectionality as a mixed-race woman of African and European ancestry and a surgeon, so it is no wonder that she would perceive and manifest diverse yet mutually enriching skills in her career or that she would notice and care about who is seen and who is forgotten, who is included and who is not, who is marginalized and how. These themes reverberate through her. They seem so natural to her that she's confused when they are not seen by others. It is imperative that she take control of her own narrative and tell her story clearly, unflinchingly so that the throughline is unmistakable because not everyone can intuitively know what she knows of intersection. She has to be a teacher. She has to know it herself and embrace the whole, sometimes messy thing, especially the nubbly parts, the parts that haven’t gone the way she hoped they would. It's not always easy. Of course, Pringl knows these things about herself and her work, but sometimes it's difficult to choose what must be specifically said.
There’s so much at stake in a medical career, so much time, money, and effort invested. Our identity is entwined with it, making any threat to our ability to perform in this capacity an existential threat. How can we dare ask for even one more thing? And yet our vitality, our inner pilot light, what captures our imagination and makes the journey interesting and worthwhile, is our animating story: our throughline. We can't afford not to attend to it.
Do you know your throughline?
Have you lost the thread of your own story or perhaps never explicitly known it and how vital it is?
Would you like help discovering it, refining it, or rewriting it?
Knowing your throughline is essential for filling the cup.
I conceived of Metamorphosis Medicine to help--and, yes, it is also an expression of my own throughline. Look around on this website to see some of the ways Metamorphosis Medicine can help support your unique physician journey. They range from hosted, no-charge weekly confidential conversations among peers to one-off consultations to ongoing one-to-one work, programs, and even small medicines (some free and some purchased) to help fill in the Missing Curriculum. Check out the notecard featuring a photograph by Dr. Miller (proceeds benefit Physician Just Equity).
Take heart, kindle joy, ask for help, know and tell your story—it is your true superpower.
PS. Click these links to learn more about Dr. Miller's MAMSE designation and the American College of Surgeons Academy of Master Surgeon Educators, her work with the American Medical Women's Association, and an article she co-authored Transgenerational Trauma and Trust Restoration published in AMA Journal of Ethics.
