The truth is, I never felt like a doctor until I was in the final year of my residency. All through residency and medical school – and even before medical school – I wasn’t sure I would ever really become one. Heck, I barely got into medical school. I was only accepted by one program, and only on my second attempt. I spent my year off selling records at Sam Goody. And even they fired me!
Many doctors have said they felt like imposters in medical school and beyond. I remember reading an article about doctors with MBA degrees – yes, I’m one of them – and the author made a distinction between business people with an MBA and doctors with an MBA. He told me no one went to business school to become a doctor. In other words, even if MDs and DOs have postgraduate degrees, they wanted to become doctors first and foremost.
That was surely my case. I had wanted to be a doctor ever since I could remember. You could say my pediatrician made a good first impression. In kindergarten, the school’s doctor (also a pediatrician) sent me home with a note after he conducted a routine physical exam. The note read: “Quite a normal boy.”
“What did you say to him?” my mother wanted to know. I couldn’t recall the exact conversation, but I remember discussing being overweight and that I loved meat and mashed potatoes. Laughter erupted from the nurse and doctor when I told them. I didn’t understand why.
In my mind, I was destined to become a doctor. My aspiration to be a physician was always top of mind, until I attended a liberal college in Boston in the early 1970s. I became part of the “turn on, tune in, drop out” counterculture. Although I never met Dr. Timothy Leary, the Harvard psychologist who coined the infamous slogan, I did meet one of his contemporaries, Dr. B.F. Skinner, a pioneer of modern behaviorism, who wrote the book on operant conditioning and reinforcement theory.
In college, I became hooked on the study of behavior and switched my major from biology to psychology. I survived the cultural revolution, but I graduated college with only a 3.45 GPA and subpar MCAT scores. My premed adviser said I would never get into medical school.
She was almost right. After a thorough trumping by a dozen or so schools, in which I was granted only two interviews (one of them obligatory from my alma mater), I had the chutzpah to call the other physician who interviewed me and showed a genuine interest in my application. Coincidentally, he was a psychiatrist, and he liked my essay, which was heavily tinged with references to mental health. It was fortuitous that we lived in the same city.
“Come to my house Saturday morning for coffee and we’ll talk about it,” he said over the phone. As a member of the admissions committee, any advice he could give me would obviously be welcomed. The psychiatrist told me to improve my GPA by taking a couple of science courses, as well as study hard for the MCATs and bring my science score up by 100 points. Wouldn’t you know it, that’s exactly what happened. (Thank you, Stanley Kaplan!)
The psychiatrist went to bat for me. “No need for a second interview,” he said. He re-presented my application to the admissions committee. I was accepted into medical school. My dream had come true against all odds. Ironically, the psychiatrist and I would later become peers and clash over everything, from policy to treatment methods.
But here is where the story gets interesting. I trained at the same institution where I went to medical school. In my final year of residency, I was elected chief resident. A patient attempted suicide while I was on call one evening, dealing a big shot to my ego, which had already suffered a terrible blow three years earlier. Although it wasn’t my fault, I felt ashamed and blamed myself for the incident because I did not evaluate the patient (nor was I asked to) when I was consulted by phone. Self-doubt spiraled into anxiety and depression.
What kind of a doctor was I? One infatuated with medicine at an early age but barely accepted into medical school? An undergraduate psychology major with a disdain for science? A resident who let a patient slip through the cracks and almost die? A doctor with a business degree? I questioned my abilities and career choice.
My confidence booster finally came during my time as chief resident. I helped run the psychiatry department’s consultation-liaison service, the arm of the department that commingled with the “white coats” and “sick” patients in the hospital. I was consulted about a patient who had attempted suicide by asphyxiation; he had put a plastic bag over his head to suffocate himself.
His wife became alarmed, naturally, and the patient was admitted to the hospital by his doctor, a famous head-and-neck surgeon who also happened to be the father of one of my medical school classmates. Eight years earlier, the surgeon had explained to me and his daughter (my classmate) the detailed anatomy of the head and neck while helping us dissect a cadaver. I’m certain he didn’t remember me this time, late on a Friday afternoon, when I was called to his patient’s bedside.
After seeing the patient and his wife, I determined he was at high risk for suicide. The patient was reeling from a recent disfiguring operation for oral cancer, an operation that also left him literally and figuratively speechless. I suggested that the patient be transferred to the psychiatry unit for treatment of major depression. I didn’t think he could wait to be seen as an outpatient.
The surgeon disagreed. “He’ll be stigmatized,” the surgeon told me. Our disagreement escalated into a toe-to-toe shouting match in the hospital corridor.
“He’s already stigmatized,” I exclaimed. “He’s suffered enough.” My reaction was swift and decisive. I didn’t even pause to get the OK for the transfer from the consultation-liaison attending. I did it reflexively, acting in the best interest of the patient.
My encounter with the surgeon turned out to be monumental. It signaled that I had arrived. Years of shame and doubt gave way to autonomy, like an Eriksonian breakthrough in psychosocial development. For the first time in my life, I felt like a doctor. And I still feel that way today, even with an MBA.
When was the first time you truly felt like a doctor?
Arthur Lazarus, MD, MBA, was a 2019-2020 Doximity Community Fellow. He is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.
Illustration by Jennifer Bogartz