1.4 You want to help people
I believe the BOAT concept — an acronym I devised — is the key to success for a happy career in medicine, particularity relating to job satisfaction. I believe it covers what I see as a fundamental concept for choosing a career in a health-care profession — not just wanting to help people, but an unconditional desire to help people.
1.4a “B” — unconditional desire to help people despite the “background” of the patient
You often cannot choose who your patients will be and what their background is. I always like to give the example of training or working in an inner-city hospital. The patients that arrive at the doorstep might be far from what you envisioned when you chose medicine as your career. You might find a patient with poor personal hygiene who is combative and rather abusive, verbally. This could be further complicated by a lack of ability for adequate history taking, making for diagnostic challenges. While this might not be a desirable situation for many people working in the medical field, there are just as many health-care professionals who prefer to work in this kind of environment. The level of satisfaction that can be gained from helping people in these deplorable situations can be immense.
You might also have strong religious beliefs and have a patient who lives a lifestyle that fundamentally conflicts with your personal beliefs, morals, and ideals. As a doctor, you cannot impose your own values on a patient. You have to be impartial when treating a patient. There are a few situations in which you might defer the treatment to a colleague if you feel uncomfortable with the situation at hand. Performing abortions is one such example. In my opinion, nobody should be forced to perform abortions, and conversely nobody should be denied a legal abortion because of a doctor’s personal beliefs.
1.4b “O” — unconditional desire to help people despite the “outcome” of the patient
Imagine going into medicine thinking that you are always going to be able to make people better? This is often not the case. Picture yourself taking care of the medical needs of a family — a mom, a dad, and two children. The one child is nine years of age, doing well at school, an aspiring figure skater, and already thinking of doing some future humanitarian work at this young age. Very suddenly, the child starts having seizures, never having had a medical problem in the past. After all the necessary investigations, an aggressive brain tumor is diagnosed. This is obviously devastating for all. Despite having all the latest treatments available, including advanced surgery, the child deteriorates, and ultimately dies. Although you can be certain you tried your best, including acquiring the help of colleagues, you have no control of the final outcome — something you have to be aware of, and be able to deal with.
Another patient of yours, a healthy middle-aged man, has elective surgery on his sinuses. During the anesthetic, there is a significant complication as a result of the patient’s previously undetected raised blood pressure. His past blood pressure readings appeared to be within normal limits. As a result, under anesthetic he is given medication to lower the blood pressure. This results in a chain of events, ultimately causing a stroke. The patient wakes up with significant impairments, including memory loss and some long-term consequences. Who would have thought that this would have happened to one of your patients? This is certainly an outcome no doctor would have wanted.
1.4c “A” — unconditional desire to help people despite their “appreciation” level
You have to want to help patients because that is something you truly want to do, without the expectation of any kind of appreciation in return. So let’s imagine you in this position:
You are a family physician working in a small rural community. There is one hospital in town, and you are covering the Emergency Room (ER) for the night. While attending a birthday celebration for one of your children, you are called urgently to the ER to attend to a passenger injured in a motor vehicle accident. You arrive at the ER to find a young woman lying in a neck brace, speaking appropriately and moving all her limbs. You investigate for many things over the next three hours, including a possible neck injury. In this case you decide the patient is stable enough to stay in the local hospital overnight.
You talk to the patient’s family to give them an update of the situation. More family members have arrived, and you now have about ten people staring you in the face and looking rather worried, which is totally understandable. If this was my sister, mother, or friend I would be worried too. While you try to tell them what is going on, they seem frustrated that you do not have more specific answers as to the exact nature of the patient’s injuries. The family also expresses concern about why you are taking care of this patient in the local hospital, and have not transferred her to the “big city hospital.” During all of this conversation, nobody has acknowledged that you have just spent three hours trying to figure out what’s going on with the patient, and little do they know that you left your own child’s birthday party to attend to their family member so compassionately and diligently. Up until now, none of the family has said the words “thank you.”
Such a situation might be upsetting for some doctors, particularly early on in their career. However, you have to understand that this family is under a lot of stress over their wife, mother, daughter, and sister being in an accident, with the exact nature of her injuries still to be confirmed. Appreciation on the part of patients and/or their loved ones might not be in the equation, at least in the short term, and you have to be fully aware of this concept before you go into medicine. There are different areas in medicine in which similar situations occur.
Don’t get me wrong — many patients appreciate what you do, but every now and again this type of situation occurs. Every doctor has his or her own story and personal take on this. So, choose medicine because you want to help people, and not because you want to receive gratitude and recognition for it. This concept is not unique to medicine, but can be of relevance to some of the other health-care fields as well.
1.4d “T” — unconditional desire to help people despite the “treats”
Together with money and status often comes other types of materialistic gain. I am sure you have all come across people who joke about doctors having fancy homes, sports cars, boats, or holiday homes. While sometimes this is the case, I think it’s accurate to say most medical doctors do not fall into this category.
If you are thinking of doing medicine and you have thoughts of luxuries as a major motivating factor, you are in for an unpleasant surprise. Often they don’t come, and then you will be a doctor without your “treats,” and unhappy in your career, which is not a good situation.
1.5 You are dedicated
I cannot think of anyone who has entered a medical field without showing enormous dedication. Achieving the grades and other requirements for acceptance into medical school clearly demonstrates dedication and determination. In order for you to proceed successfully in this career, these qualities are definitely required. There is no area of the health-care fields in which you do not need commitment in order to go forward and succeed.
Let me give you an example of how dedication can clearly be displayed by a person. Let’s call this person Joe for the sake of the illustration.
Joe always wanted to be a doctor from as young as he can remember. He is also a star athlete, ice hockey being his strongest sport. Joe, while having the ability to excel in the ice hockey world, has decided to pursue his life-long dream of becoming a medical doctor. Due to the enormous amount of time spent on hockey training, Joe’s grades are not fantastic, but they are good enough to apply to medical school.