Since I retired, I have repeatedly been asked two questions. “How do you like retirement?” and “Don’t you miss practicing medicine?”
The answer to the first question has been evolving. At first I begged off with: “It’s too early to tell.” That slowly transitioned to: “It’s a learning process.” (Often followed by a conversation about the challenge of deciding what to do every day instead of letting the schedule decide for me.) These days I talk about how much fun I am having with my grandchildren and how nice it is to have both time and energy to pursue longterm passions for Nordic skiing, hiking, woodworking, computer programming, photography, writing, reading, and guitar.
My answer to the second question hasn’t changed much. Yes, I miss practicing medicine. A lot. And, despite how busy I am and how much fun I am having, the pain of my withdrawal from practice shows no sign of abating.
There are things I don’t miss. I don’t miss the constant fatigue. I don’t miss the fear that I will make a preventable mistake and cause pain or harm, or even death. I don’t miss the stupid policies and procedures that made it harder to do the real job of helping patients. I don’t miss the sadness and anger when bad things happened to good people. I certainly don’t miss the loss of autonomy and the madness of watching a patient-centered practice become a medical business after it was acquired by a local hospital.
Overall, though, the frustrations of practice were dwarfed by the rewards.
First and foremost, I miss my patients. They were (and presumably still are) great people, wonderful in their diversity, authenticity, engagement, and willingness to share with me. I miss being invited into their lives, and allowed to share their triumphs, trials and even tragedies. I miss their concern about me when I was ill or having a bad day (or week). I miss them asking me questions about health and medicine, and answering my questions about their work, travel and hobbies. I miss the magic that happened multiple times a day when I entered a room, closed the door, and asked how things were going and how I could help. I miss the blessing of a thousand friends. If any of my patients are reading this - thank you for all you gave me.
I also miss solving problems. Some of the problems were medical: what could be causing this consultation of symptoms, why is it not responding to treatment, how do we manage the side effects of treatment, how can we find out more about what is going on? Some of the problems were more psychosocial: how can we help this child succeed in school, how can we make the treatment more affordable or more tolerable, how can we maximize the function and joy for this person despite their illness, how can I help this person understand without being overwhelmed by what they learn.
I miss the constant learning. The science of medicine changes at a breakneck pace, and keeping up with everything isn’t possible. The trick was always being open to learn new things, not just about new developments but also about old problems. Sinusitis began as ‘a thing’ I learned about in medical school and residency, but in practice it quickly became a collection of medical syndromes with different presentations and treatments, based on constantly growing and changing (and often contradictory) science. In addition, even if the ‘sinusitis’ was the same, each patient with sinusitis was different, and different in ways that one can only learn about from the patient. It both saddened and puzzled me to hear clinicians complain about the growth in what there was to know and the impossibility of mastering it all. I saw this not as a recipe for failure but as an opportunity to learn and grow every day.
I miss the team I worked with. I was fortunate to be surrounded by a tight and supportive community of nurses, clerks, secretaries, lab techs, and clinician colleagues who shared my commitment to the patient above all else. They both had my back and refused to let me off the hook.
I even miss, at least a little bit, the demanding and often rigid structure of my life. Even while I complained that it stood between me and things I wanted to do, I took comfort in knowing I could count on being busy doing important things with a good team for appreciative patients.
Looking back, I think of a Nietzsche quote. : “There is one thing one has to have: either a soul that is cheerful by nature, or a soul made cheerful by work, love, art, and knowledge.”