Ghosts of Christmas Future

Compared to most doctors, I’m still optimistic when it comes to the practice of clinical medicine.  Despite routinely seeing dead people, I still think it is a privilege to care for patients. Even though a medical career may leave a trail of civilian casualties in its wake, there is no other job I’d rather do. (It doesn’t hurt that a physician salary is like winning a jackpot.)

I don’t pretend to have achieved a good work/life balance.  Like Ebenezer Scrooge, there are times when my life becomes All Work and No Play.  What finally saved Scrooge was a visit from the ghost of Christmas future. He needed a good scare to convince him that there was more to life than work.

Screen Shot 2018-12-26 at 6.22.50 PM
Boo! Time to retire.

I’ve never seen a ghost, but I do know what could make me walk away from medicine.  I’ve seen what forced my older colleagues into retirement, and I’m sure that one of these three things will put me out to pasture.

Too Scared

We’ve all seen it. We all know a doctor who lost their nerve. This job requires you to stay calm under pressure.  You may be making multiple life and death decisions in a single hour.  You may spend your days doing complex procedures on high risk patients.  Once fear sets in, it starts to take over every aspect of your practice.

For ER docs, it starts when you get scared of critically ill patients. You start letting your coworkers take the sick cases. You find reasons not to intubate or place central lines. When the nurses say “we need a doctor in room one” you make a bee line for the water cooler. As you get rustier, you only get more scared and create a vicious cycle.

Fear can creep into other aspects of your practice too. You may start over-testing out of fear of missing a diagnosis. You may start over-consulting out of fear of getting sued.

Once fear takes over, it is hard to shake. If you find yourself avoiding sick patients or over-utilizing tests and consultants, it’s time to look for the exit.

Too Slow

I take pride in being the most productive doctor in my group. I love walking into chaos and taming a busy department. I like being the guy who is greeted with “thank God you’re here”. I also love that my eat what you kill secret recipe yields an above average salary.

I have already accepted the fact that I won’t stay king of the hill forever. Eventually some young whippersnapper will have more drive and more energy. I can accept the fact that I will eventually become *gulp* “average”. What I can’t stand is the thought of being the snail that drags the ED to a grinding halt. I never want to be the person who elicits groans and winces from the other doctors and nurses when they see my name on the schedule.

close up of snail on ground
He may be slow, but his Press-Ganeys are through the roof!

Whenever I start becoming more of a liability than an asset, it’s time to throw in the towel.

Too Sick

Unfortunately, many doctors need a health scare to nudge them into retirement. These health scares usually come in one of two flavors.

The first health scare is when the doctor gets ill. Whether it be a heart attack, a cancer diagnosis or a chronic painful condition, something makes the doc realize that they are in fact mortal.  Years of treating disease has made them feel immune to all the normal wear and tear that comes with being human.

grayscale photography of patient and relative holding hands
Surprise!  You’re mortal.

The second type of health scare is when someone they love gets sick. We often lie to ourselves and say that after decades of workaholism we will finally retire and start spending “quality time” with the people we love.  Sadly, sometimes the people we love get sick or die before we reach the finish line.  Nothing resets your priorities like the thought of losing someone you love more than you love yourself.  I’ve known multiple doctors who only retired once their spouse received a terminal diagnosis.

Have you ever seen a ghost?

Some docs can’t wait to retire, while others will need a not-so-gentle nudge to hang up the stethoscope for good. I know what would finally push me into retirement. The day I become too scared, too slow or too sick to do this job, I’ll know my days are numbered.  I hope I don’t see these ghosts for a long time.

What do you think? Are you ready to walk away from medicine, or will it take a ghostly visit to scare you away? Share your thoughts and comments below.

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5 thoughts on “Ghosts of Christmas Future

  1. I see the big three you describe lurking in the corners, waiting in ambush to see who the next doc/victim might be.

    Last year, I intubated a 3 year old with stridor after a cleft palate repair. My sphincter tone could have made coal into diamonds for a couple of weeks afterwards.

    I find myself humming the refrain from Warren Zevon’s opus, “My sh*t’s f’d up” more often theses days, which is, “It will happen to you…”

    Enjoy your insights as always, my friend,



    1. A big part of why I like my job is the pride I take in doing it well. It is natural for us all to slow down and get more fearful the longer we do this job. I hope I am self-aware enough to know when it’s time to hang up the stethoscope for good.


  2. For me it is how much longer do you want to play in the game when you have won it.

    The only correlate found between malpractice lawsuits and doctors is the length of the career. They say that pretty much every doctor will get sued during their career. For those that haven’t how long are you going to play russian roulette?

    Right now I am probably at the peak of a radiologist career in terms of knowledge and physical ability (vision, endurance), etc but I have no problem doing a Barry Sanders and leaving when I feel I have padded my nest egg enough.

    Don’t hate the playa, hate the system.


    1. I agree that when it comes to investing there is no point bearing more risk than necessary. People should cash in their chips when they’ve won the game.

      From a psychological standpoint though, work gives many physicians a sense of pride and purpose. As long as I find this career personally rewarding, I will be more of a Brett Favre than a Barry Sanders.


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