Lessons Learned: Reflections on Prioritizing Relationships in Academic Medicine

Training in academic medicine is an extended adolescence.  When we’re in training, we have real responsibility, and the stakes of our missteps may be pretty high.  Still, there’s always a safety net: somebody else with the ultimate responsibility who has the know-how and resources to clean things up if we fail.  Understandably, we’d rather not use this safety net, so we pour everything we have into learning physiology, figuring out how to phrase things just so, and practicing the skills that will become our life’s work.  This singular effort means a lot of things fall by the wayside.  I knew I was risking my relationship with my Midwest-based family when I ranked a West Coast fellowship number one on my list, but since I thought I wasn’t good enough to match there, I didn’t weigh the pros and cons of moving so far away from them.  When I matched, there was no question I was going; any consideration of only seeing them a couple of times a year was buried in planning a cross-country move.  It wasn’t just the distance but also the realities of practicing medicine that meant I missed a lot of time with them.  I missed holidays, milestones, and many phone calls because the time difference had to be just so for me to make (or take) a call.  But my family’s loving and amazing, so they understood.  I also had great friends, but they were all in the same position that I was, moving to all corners of the country for training.  Hence, those relationships naturally became quarterly check-ins, usually via asynchronous voicemails to signal we were each alive.  Social media was becoming a thing then, and we eagerly embraced it because it made staying connected easier.  Given how I feel about it now, it’s very ironic that I was relieved to have social media back then.  I don’t know exactly how I feel about social media now, but it’s certainly not “relief.” 

My training life was easier because I wasn’t coupled up, so maintaining a significant relationship with a partner was an intermittent undertaking (at best), and having kids was nowhere in the immediate future.  I didn’t even have a pet.  Or a houseplant.  While the conscious thoughts during this time were something like, “This all-in focus is necessary to learn medicine,” the unconscious thoughts were things like, “I’ll have time for everything else later.”  Or even, “They’ll all still be there when I’m done.”  Thankfully, this is not a cautionary tale full of despair: I had time for my loved ones later, and they were still there when I finished training.  But there was a rebuilding period in my relationships after training, even with my friends who had finished their own training gauntlets.

My loved ones, family, and friends were different people when I finished training.  They’d gone through a big chunk of their lives while I was becoming a pediatric intensivist, and I’d played a small part, at best, during it.  Of course, I’d changed too.  Would I have changed differently had I made more of an effort to stay connected to those who knew me best when I was younger?  I’ll never know, but I do know that it wouldn’t have felt like so much work to rebuild the relationships that had simmered on that back burner.  That process didn’t start on July 1st of my first faculty appointment either: by that point, seven years of patterns had played out, seven years of my learning medicine taking precedence over my being a good daughter, granddaughter, niece, and friend.  The people who’d supported me most during my entry into medicine had become an afterthought once I was in medicine.  Those patterns took time to re-direct.

Of course, becoming a physician is hard.  Sometimes, it does take singular focus.  But it doesn’t have to be all the time.  And I think how medicine is taught might be changing so that it doesn’t require a singular focus on most of the path.  But only time will tell whether that’s true and what the outcome will be if it is.  I can say now, though, with the rates of burnout and general ennui with the state of practicing medicine, we don’t have time to wait until the practice of medicine changes before we start making room for the people we want in our lives.  Those are the relationships that keep us honest.  Those relationships make us realize when our “Because I’m the doctor” egos have been left to run off-leash.  Those relationships pull us out of academic medicine’s ivory towers and remind us that, first and foremost, we are whole, loved, and valued human beings.  Human beings who then went on to become doctors.  Sure, the people you want in your life will probably still be there when you’re done with medical training.  But imagine how much better medical training would be if they were in your life now.  Will spending 10 more minutes cleaning out your email inbox appreciably change the trajectory of your day?  Instead, would a 10-minute phone call with your grandma be a good idea?  Which would be more fulfilling: scrolling social media between patients or sending your former co-fellow a “Hey, I’m thinking about you” text?  Thinking, “But I don’t have time for that,” is precisely the signal that you need to make time for it.  And you’ll be surprised with how little time it takes, especially in proportion to how good you feel afterward. 

With that, I’m going to ignore my charting for another little bit.  I’m going to call my grandma.