When we become doctors, we install a new operating system. Or maybe it’s installed in us, depending on your perspective. There’s the hardware we start with: the brains, drive, and talent that help determine our potential. Then, we superimpose this system from which we operate, that will set us apart for the rest of our lives. If you leave medicine, maybe you’ll miss some system updates, but I think remnants of the doctor OS will always remain. There’s no going back once it’s in. And there is a reason many other staff members in the hospital don’t work or think the way we do. They don’t have the same OS. You may as well hear it now. I was surprised. Because becoming a doctor means installing a completely new operating system.
Many people come to healthcare with the same compassion and drive as budding doctors, but with a different intent. They buy into helping others, but not at the expense of themselves. They haven’t been indoctrinated with the same self-sacrificing ethos as we have. It’s called residency, where they reinforce this OS, bolstering it with firewalls against our alternate realities. But the installation starts in medical school. That’s when the idea of holding your urine as long as possible, or at least until the end of this study module is installed in your psyche. Putting your needs aside becomes your modus operondi. You’ll get coffee as an excuse to move from your study cubicle.
On rotations, you learn that you don’t eat if there is work to be done. You certainly wouldn’t stop to eat while you’re halfway through an operation, so you may as well get used to ignoring that need. Food is really just a “want” anyway, right? We learn to “eat when you can,” or “sleep while you can,” and that attitude bleeds into the rest of our lives, too. The doctor OS dictates when it’s appropriate to perform other self-care activities too. Because food and sleep were primary concerns until you got your new OS. It’s only natural to believe that other needs are even farther down the list. So sometimes you don’t see your own doctor for a few years. This system teaches us to put ourselves last, so it’ll be your job to reinstall self-care in your life. It’s not part of the doctor OS, and it might even mess with some of the scripts.
State labor laws and union rules don’t generally apply to physicians, but they do to other disciplines in healthcare. Our operating system prepares us for this fact, I guess. We don’t have any (true) hour limitations or mandated breaks as physicians. We don’t get to just “go to the dentist,” as our administrators do.
When we install this medical OS, I think we uninstall or purge some of our old OS, to make room in the old memory, for these new ways of operating. That’s why you will never be the same after medical training. You may as well accept that now, wherever you are in your path towards becoming a doctor. There’s no going back really.
You will never be the same after medical training. You learn through standardized test-taking that comprehension and seemingly infinite shades of correctness require such a precision you’ve never known before. When a small mistake could mean harm or death to a patient, it’s only natural we operate in such an exacting way. We sacrifice nights, weekends, and holidays in the name of this work, as our OS hums in the background. The work of a doctor has a weighty, gravitational pull that affects lives and families, and ironically, our families might never understand. They won’t understand if they’re not in medicine. Our operating system allows us to take on an extreme amount of responsibility, beyond even that which is in our power to control. It’s almost inhuman. And it can be inhumane.
But you’ll still need to work with others on a different operating system. They will punch out as you’re struggling to care for every last patient. They might have a vague idea, but not truly understand the responsibility you hold. They’ll think of their feelings first, but you can’t. They’ll call you demanding and difficult. You’re not– but you are on a different OS. And you know the stakes demand it. Others don’t know how many nights you’ll lie awake if there’s a bad outcome, but it’s the shadow we live in as doctors. And we think, “If I just flagellate myself a bit more, it’ll be easier to stomach if anything bad occurs.”
This is the default, and the challenge of moving through life on a physician operating system. Ours is a high-speed, intricate data cruncher, and a driving program that doesn’t allow for much rest… not as much as other humans, anyway. As we move in an imperfect system in an imperfect world, it’s not easy being on the doctor OS you’ve received. Patients and their families hold high, sometimes supernaturally-high expectations, and often, we deliver, thanks to this operating system driving us.
Just don’t expect others to think or act like you, because they are not on the same system. And don’t expect you’ll ever be the same once your new OS is installed.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.