What Kind of Doctor Do You Want To Be?

And why the answer is probably not what you expect

Now that’s a cryptic title.
Almost like the headlines of certain horrifically biased newspapers which I won’t mention, but will strongly imply.

It’s actually a really good question and my answer probably won’t be what you’d expect. Cryptic.

I thought I’d address this question which I often think about, as we now approach the 1 month mark of those in training working at their current level. Be it F1, F2, CT1 (that’s me!), or those very wise people at ST7+. Hopefully, my answer will make you think a little bit.

The problem with medical school

When you start your first day of med school, I think you have this great sense of ‘waw, I’m going to be a stethoscope wearing rockstar’.
I did anyway.

I’d worked really hard for it. I was proud of myself and it became a pretty constant talking point in all family chats. You soon realise after about a week of lectures on gap junctions, the Krebs cycle and protein synthesis, that this initial sense may have been a little wrong. For now anyway.

Pre-clinical sciences are a fantastic method of making you feel like an idiot. It doesn’t help that you’re surrounded by other ‘high achieving’ students who look like they know everything and seem as though they were casually aware of said gap junctions since the age of 4. In actuality, everyone is clueless. Everyone is struggling. Everyone thought medicine would be a bit more sexy than a sodium-potassium-chloride co-transporter.

After many more months of suspiciously made up sounding Latin words, you start to get the hang of things. You still don’t know how to wear or even use a stethoscope properly, although admittedly you still pretend to, but you’ve started to figure out that not all medical students are made equal.
Some people love anatomy. Some love physiology. Some love pints.
Even if you hate a certain part of medicine, you start to find something that vaguely interests you at least.

You move through more years of med school and enter the juicy clinical years. You get exposed to different specialties and personalities in the real world. You start aligning your identity to certain specialties. Some have decided they’ll be surgeons. Others know the exact branch of cardiology they want to go in to. The vast majority have absolutely no idea, but they have mastered the art of “going to teaching” and not coming back.

Regardless, you’ve started to build your identity. Med school will reinforce this identity.
Unfortunately, and I was guilty of this, you’ve built that identity around an area of medicine. Not the type of medic you actually want to be.

In my case, I knew I enjoyed physiology, I liked procedures, I liked working in a team and I really really hated anatomy. Okay, I don’t actually hate anatomy, but I hate just remembering things for the sake of remembering. My brain works best when it can understand something. Anatomy, generally, for me, didn’t fulfil that.

By the powers of deduction, I had landed on Paediatrics. It ticked many of those boxes. Evolving physiology, some procedures, big teams, minimal remembering the name of a random artery in the abdomen.

Building your identify around a specialty is, on reflection, a bad idea. Especially when you’re still in med school.
Hindsight is a wonderful thing.

Who actually are you?

Believe it or not, but we all have lives outside of medicine. Even if that life is simply adding hot water to a pot noodle. It is still a life outside of medicine.

Me? I’m a bit of an odd-ball.
I cycle through hobbies like there’s no tomorrow. And I also cycle in the traditional two wheeled sense.
I’m a nerd.
I like asking really bizarre questions like ‘could you throw a baguette or a naan further?’
I’m a coffee snob/connoisseur.
I really like dogs.
I really like cats.
I’m really bad at cancelling subscriptions.
I’m always boiling and wear shorts in winter.
The list goes on and on.

It’s really hard, especially when you’re trying to figure out what part of medicine you fit in, to remember the little things which make you, you. But what and who you are outside of medicine will help you decide what kind of doctor you want to be.

You can spend a lot of time deciding where you want to work within medicine, without ever really asking who you want to be when you get there.

So why does this matter?

As you go further through medical school, graduate and then start work as a doctor, all of that identity you built around a specialty starts to become increasingly difficult to maintain.

Because medicine has an annoying habit of ruining your plans. You might discover that the specialty you were absolutely convinced was your calling makes you miserable. You might fall in love with something you previously thought sounded horrendous. You might apply for one specialty and end up doing another.
You might spend years telling everyone you’re going to be a paediatrician and then, entirely hypothetically of course, end up putting adults to sleep for a living.

Life comes at you fast.

And this is where I think we sometimes ask ourselves the wrong question.
Throughout medical school and Foundation training, we constantly ask:
“What kind of doctor do you want to be?”
But what we really mean is:
“What specialty do you want to do?”
Those are not the same question. Not even slightly.

Being an anaesthetic trainee tells you what part of medicine I work in. It tells you that I spend an unhealthy amount of time thinking about airways, physiology, blood pressure and whether somebody’s cannula is actually working despite them confidently telling me that it “flushed earlier”.
It does not tell you what sort of doctor I want to be. And I think that distinction matters.

Forget the specialty for a minute

Imagine I somehow develop a personality crisis tomorrow and decide anaesthetics isn’t for me.
Terrifying, I know.

Would all the things I value about being a doctor suddenly disappear? Hopefully not.
I would still want to be calm when things go wrong.
I would still want patients to feel that I had actually listened to them.
I would still want colleagues to feel comfortable asking me for help.
I would still want to make people laugh when the situation allows it.
I would still want to be kind.
I would still want to be somebody who admits when they don’t know something rather than attempting to bluff their way through it with a sufficiently confident facial expression.
And, obviously, I would still want to be really bloody good at cannulas. Because we all need ambition.

Those things aren’t anaesthetic traits. They’re my traits. Or, perhaps more accurately, they’re the traits I’m trying to develop.
And that’s what I mean when I ask 'what kind of doctor do you want to be?'

The doctors you remember

Think about the doctors you’ve really admired.
Not necessarily the professor with seventeen postnominals, four fellowships and a publication list long enough to require its own ISBN. The ones you actually remember.

I can think of doctors I worked with as a student years ago whose clinical knowledge I could tell you almost nothing about.
I have absolutely no idea whether they could recite the branches of the external carotid artery. Frankly, I hope nobody ever asks me to. But I remember how they behaved.
I remember the consultant who stayed calm when everything around them was going spectacularly wrong.
I remember the registrar who took five minutes to explain something to me when they were clearly very busy.
I remember the doctor who knew everybody’s name.
I remember seniors who could walk into a stressful situation, make one terrible joke and somehow reduce the collective heart rate of the entire room.
I remember people who said:“I don’t know. Let’s find out.”
I remember the ones who made nurses, students, resident doctors and patients feel like their opinion mattered.

And, unfortunately, you remember the opposite too.
You remember the people who made you afraid to ask a question. The people who knew enormous amounts of medicine but somehow made everyone around them feel about three inches tall. The people who could diagnose a disease from twenty metres away but apparently hadn’t yet mastered saying please.

Clinical ability matters enormously. Obviously.
I would personally prefer that the person anaesthetising me had at least a passing familiarity with anaesthesia. But knowledge and technical competence are only part of what makes somebody a good doctor.

Your reputation is built in very small moments

I think we imagine professional identity as something enormous.
Awards. Research. Qualifications.Job titles. Getting letters after your name until airport check-in forms can no longer cope.

But most of your reputation as a doctor probably gets built through hundreds of completely unremarkable interactions.
What do you do when the ward nurse tells you they’re worried? (FYI, you should be worried)
How do you respond when an F1 asks you something you think is obvious?
Do you introduce yourself to the patient?
Do you say thank you to the person who helped you?
What happens when you make a mistake?
What happens when somebody else makes one?
What are you like at 4am when you’re tired, hungry and have just been bleeped about potassium for the seventeenth time?
That last one may be the true test of character.

Nobody gets all of this right all the time. I certainly don’t.
There are days when I’m tired, grumpy or distracted.
There are conversations I replay afterwards and think “Hmm. Could probably have been less of a knob there.”
But I think knowing what sort of doctor you want to be gives you something to aim back towards.

So what kind of doctor do I want to be?

This answer has changed considerably over the years.

At one point, I probably would have answered:
A paediatrician.
Then:
An anaesthetist/intensivist.
Now?
That isn’t really my answer at all.

I want to be the doctor who stays calm when everyone else is panicking. Not emotionless. Not pretending nothing is happening. Just calm enough to think.
I want to be the doctor who is kind when being kind is easy, but more importantly when it isn’t.
I want to be approachable. I want students and junior colleagues to feel they can ask me a stupid question, mainly because I continue to ask an impressive number of them myself.
I want to make people laugh. Medicine can be miserable. Patients are scared. Families are worried. Staff are tired. Sometimes things are just objectively awful. There are obviously situations where humour is completely inappropriate. But there are also plenty where being able to make somebody smile is genuinely valuable.
I want to be good at explaining things.
I want to admit when I’m wrong.
I want to keep being curious.
I want to be the sort of doctor whose first thought when somebody disagrees with me isn’t “How dare you?” but “Have I missed something?”
And yes. I want people to say “Steff? Oh yeah. He’s really good at cannulas.”
I cannot emphasise how important this final point is to my professional development.

Specialty still matters

None of this means specialty choice is irrelevant. Clearly it matters. The job needs to suit you.

If you hate being awake after 10pm, emergency medicine may present some logistical challenges. If the sight of an operating theatre makes you want to escape through the nearest fire exit, surgery is probably going to be a difficult long-term relationship. And if you despise physiology, anaesthetics may involve an unfortunate amount of it.

Choosing a specialty that matches what you enjoy, how you think and the life you want is important. But your specialty should be part of your identity, not the whole thing.
You are not just The anaesthetist. The surgeon. The GP. The paediatrician. The emergency medic. Before all of that, you’re a person who happens to practise medicine.
And the characteristics you bring into that job will follow you regardless of what is written on your lanyard.

So, what kind of doctor do you want to be?

Maybe you want to be calm.
Maybe you want to be compassionate.
Maybe you want to be the person people call when things get difficult.
Maybe you want to be an excellent teacher.
Maybe you want patients to feel heard.
Maybe you want to challenge bad practice.
Maybe you want to be technically brilliant.
Maybe you want to make people laugh.
Probably several of those. Hopefully not exclusively the cannula one.

The point is that none of these requires you to have already figured out your specialty. You don't need to know whether you're going to be a cardiologist, psychiatrist, anaesthetist or something else entirely before you can start becoming the doctor you want to be.
You start building that person now. One interaction at a time.

So perhaps the next time somebody asks “What kind of doctor do you want to be?” Don't answer with a specialty.
Think about the person. I suspect that's the more important question.

Four Eyed love,
Dr Steff