What Does It Mean to Have a Calling to Medicine?

BQO-Curlin-990-x580via YouTube

Twenty-five years ago, just months before I was to enter medical school, I served as a translator for a surgical mission. A team led by plastic and general surgeons from the University of Minnesota descended on a small concrete-block dispensary in the highlands of Guatemala, turning it, for one week, into a makeshift surgical hospital.

Guatemalan colleagues had already screened and selected a full slate of patients — enough to keep two operating rooms going twelve hours a day for six days. And then Sebastian arrived.

Sebastian was 28 years old. He had been born with a deeply cleft lip and palate. And because he was born poor in Guatemala, his craniofacial abnormality had never been corrected. It was difficult to look at Sebastian. His upper teeth were twisted into the cleft, tenting up his nostrils. When he ate, food sputtered into his nose and sinuses.

The surgical outreach was to run from Monday to Saturday, and somehow, the Sunday before it began, Sebastian found out about it. He dropped everything to travel several hours by foot and on buses until he arrived at the clinic late Monday afternoon. There he learned that he was too late. He would have to wait until a future year, because the schedule was already full, indeed too full, of patients.

But Sebastian had already waited too long to give up now. He refused to leave. Instead he sat all day just outside the entrance to the infirmary. He slept all night on its stone steps. Every time the surgeons and anesthesiologists passed by, he would plead: Please help me. I’ll do anything. Please.

This went on day after day, until the morning of the final day, when the head surgeon suddenly announced to the team, “If we can finish the scheduled cases by 5 p.m., I am going to add this Sebastian guy on.” They didn’t finish the scheduled cases until 7 p.m., but by then no one was willing to turn Sebastian away. He was already on a gurney being prepped by an anesthesiologist, his eyes flashing with the eagerness I think blind Bartimaeus must have felt when Jesus spoke to him. The surgeon explained that, in accordance with standard protocol they would repair the cleft palate now, and Sebastian would need to have the lip repaired in the future after the palate had healed. Sebastian shook his head wildly and begged, “Please do both operations. I don’t care about the risks.” Perhaps the surgeon was too tired to argue at that point, but he conceded. Okay. We’ll try to do both.

For the next four hours I watched a small miracle unfold. As most of the team members were breaking down equipment and packing up for the flight back to the United States, all three plastic surgeons crowded into Sebastian’s O.R., working in an almost mystical harmony to reconstruct the patient’s palate and lip as quickly and effectively as possible. And when the surgeons finished, the result was magnificent — of the 10 or 12 cleft repairs done that week, none resulted in a more anatomically clean and precise appearance. Sebastian looked like a man who had been hit by a broken bottle, but you could tell he would heal up fine. His life, quite literally, would be transformed.

As you can imagine, the moment was thrilling. I had seen doctors at work, and I was captivated.

Vocation and “Pretending”
What does it mean to have a calling to medicine? And how does one actually become the physician one feels called to be? Every summer, at medical schools around the country, young men and women go through “White Coat” ceremonies to mark the beginning of the long adventure that is medical training. In donning their white coats—the traditional garb of physicians—these students are, of course, only pretending. They are no more physicians than they were the day before.

In a critical sense, however, this pretending is intrinsic to being a physician, and, indeed, to being human. Jonathan Lear, a philosopher at the University of Chicago, notes that to be human is to pretend, because to be human is to put ourselves forward in our various social roles and practical identities. We put ourselves forward as worshipers and as skeptics, as fathers and mothers, as friends and colleagues. And we put ourselves forward as physicians. That is what the white coat symbolizes: a new way of putting oneself forward in the world.

And in putting ourselves forward, we know that our pretending may fall short of what it proposes to be. I know down deep that in putting myself forward as a physician, I may fall short of being a physician.

Before completing their training, medical students do not yet know how to put themselves forward as physicians. They are taught by senior physicians in prescribed, ritualistic, time-tested ways. They study biochemistry, pathology, physiology, embryology, immunology — indeed all of the “-ologies” that constitute medical science, and they learn to put themselves forward as people who make use of all of this medical science to preserve and restore health.

They learn also that medicine is much more than scientific knowledge. It is a practice of attending to those who are sick. So an important part of medical education is learning to put oneself forward as a clinician, as one who attend to patients. This means knowing how to introduce oneself to patients, to establish rapport, to ask questions, to listen, to examine, to counsel, and to cultivate doctor–patient relationships that facilitate rather than frustrate healing.

Gradually, the way medical students put themselves forward as physicians comes to seem less like pretending. The strange new vocabulary — several thousand new words in the first two years — becomes the grammar of a fluent second language. The practices they initially imitate awkwardly become as familiar as combing their hair or tying their shoes. The norms and commitments of their teachers become their own. Their white coats look less crisp and bright but feel more comfortable; and, eventually, the coats start to fit. The students have become physicians.

Yet, even then — even when and they receive the official title of doctor, even five or ten or twenty years into their careers when doctoring is as familiar as their own voice, physicians will still sense that in putting themselves forward, they often fall far short of being the physicians they have been trying for years to become.

That is the nature of things, not only because living up to the best standards of medicine is incredibly difficult (it is), but also because at times the standards themselves fall far short of capturing what it means to be a physician. In other words, a physician who is characterized by patient-centered communication, hitting quality-care benchmarks, medical professionalism, and any number of other socially prescribed standards may still be arrested by the sense that all of this falls short of what it would mean to become the physician he or she is called to be.

By falling short I don’t mean failing. It is possible to be a terrific medical student while recognizing that you are never fully the student you should be. And it is possible to be a terrific physician while never becoming fully the physician you aspire to be. Thankfully, if we recognize that our grasp on what it means to be a physician will always be partial, incomplete, we can let go both of the anxiety that we do not measure up and of the presumption that we do.

Becoming a Physician
My hope for each young doctor is that they will come to experience medicine as a vocation. Vocation is originally a theological concept — the idea of a work or occupation within a faithful community, to which one is summoned or called by God. Many come to medicine with just such a sense of calling, and to understand and work out how medicine fits within a good and faithful life, physicians will need to probe the depths of their moral traditions, whether religious or secular.

Medicine as vocation differs from medicine as merely a job. Insofar as one practices medicine as a vocation, one does so for the rewards internal to the practice, e.g. the rewards of attending to those who are sick, of bringing a measure of health, of comforting the dying, and so on. In contrast, insofar as one practices medicine as merely a job one does so for external rewards—for money, or prestige, or security, to please one’s parents, or just to get by. To practice medicine in this latter way is akin to play-acting; it is to act out a role but keep that role at a distance. It is a form of detachment from the call that medicine makes on one’s life.

To practice medicine as a vocation is very different; it means putting oneself forward not merely as a physician but in order to become a physician. Becoming a physician is not easy. It is hard to get the hang of it. But becoming a physician is a high calling, worthy of a lifetime of effort.

Discussion Questions:

  1. How can we invite medical trainees to explore the meaning of the work to which they believe they are called?
  2. How does one discern a vocation to medicine or another profession?
  3. Are there ways in which we all, whatever our careers or vocations, are “pretending” to be what we are striving to be?

Discussion Summary

Our discussion pushed further into what it means to have a calling in medicine. One reader asked how one discerns a vocation to a practice like medicine and whether such discernment bears any similarity to falling in love. I suggested that it is indeed similar to discerning a vocation to marriage, with the key difference that the profession of medicine is not necessarily “for life.” Another reader asked whether being a doctor is the kind of thing “you can get real practice in…when you’re very young,” as with some other professions. I pointed out that while there is no way to do that, exactly, there is something to the cliché that medical students are the people who showed an early aptitude in science and liked to “help people.” In the end, however, one cannot understand what it really means to practice medicine until one has become a physician, so embracing a call to medicine requires something of a “leap of faith.”

[An earlier version of this reflection was delivered at a Pritzker School of Medicine White Coat Ceremony.]

6 Responses

  1. Emmeline Wood says:

    How do you actually discern a vocation? Is it like falling in love? Because people fall out of love, and getting a medical degree only to realize that you don’t really have a vocation for it after all seems like it would be an expensive undertaking.

    • Farr A. Curlin Farr A. Curlin says:

      Well, it really is like discerning whether your vocation includes marriage to someone. First there needs to be the aptitude. Are you prepared to take on the commitment of marriage to this person? Are you prepared to take on the commitment of becoming a practitioner of medicine? If the answer to either is no, then your vocation does not (yet) include that pathway. Next there should be affinity. Do you really want to marry this person? Do you really want to be a physician? If not, marriage (or medicine) might remain a possibility, but probably not a satisfying one. Finally, there needs to be opportunity. Many people who think they are called to medicine find they are not because they cannot get accepted to a medical school. Many people who think they are called to marry a person find they are not, because that person declines their offer. The commitment is indeed costly, because, as with marriage, one cannot get full knowledge of what it means to practice medicine until one is formed into a practitioner. I don’t, however, see a way to get around the existential leap that one must take. Thankfully, unlike marriage, which is a vocation for life, it is permissible to leave the profession of medicine if one has sufficient reason. Many physicians do.

  2. Brandon84 says:

    I like this idea of the “becomingness” of being a physician.

  3. Reihan says:

    For some people, their sense of a “calling” or career path goes back to a time, often in their childhood, youth, or early adulthood when they got really good at something and later discovered how much they would like doing this “for a living.” I’m thinking of a teenager who begins tinkering with computers and gets good at fixing them and really comes to love it. Or a student might get good at helping others with math and develops a passion for teaching. But I actually wonder if this type of scenario plays out much in medicine. It’s not like you can get real practice in being a doctor when you’re very young. Or can you?

    • Farr A. Curlin Farr A. Curlin says:

      No you cannot, at least not in the North Atlantic countries, where there are strict boundaries around children learning from practitioners “on the job.” With respect to medicine, the trope we all know is that medical students are people who were good at science and wanted to “help people.” That is an oversimplification, but there is something to it. However, as you note, one cannot understand what it really means to practice medicine until one does it, and one cannot do it until one has completed a long and intensive course of formation.

  4. Adam Keiper says:

    Readers who enjoyed this essay by Dr. Curlin might also like the blog “Practicing Medicine” that we publish at BQO’s sister magazine, The New Atlantis. The blog is written by a young doctor, Aaron Rothstein. It’s his account of learning and discovering the inner workings and moral complexities of medicine. You can find it here: http://practicing-medicine.thenewatlantis.com/

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