anecdotal evidence

This is a second post on career choices. In the first post, I wrote about three of the reasons I seriously considered shifting from clinical medicine to non-clinical work:

1. It’s an interest where I think I can have marginal benefit.
2. A license to practice as a health professional is an incredible safety net.
3. Any clinical career I’d consider isn’t hyper-competitive, so there’s less pressure to get onto the training treadmill as soon as possible.

Having decided to hang up the stethoscope for a bit, the next choice was figuring out what to swap it for. There were three principles that went into the decision:

1. Principle 1 – I wanted to lean into the decision to do something non-clinical
2. Principle 2 – I wanted to build new skills
3. Principle 3 – I wanted to do something exciting

Principle 1 – I wanted to lean into the decision to do something non-clinical

After deciding to step outside of the hospital walls, it soon became clear that there was quite literally a whole world outside waiting for me.

There was no need to do something related to clinical medicine or even adjacent to it. The enviable job security of the (extortionate) AHPRA registration meant that I could do just about anything and get back in with a locum job if I ever needed to.

So, I explicitly looked for jobs that would need none of my hard skills (I genuinely think one of my top 5 lifetime achievements was one particularly difficult cannula I got during internship) and that would be totally unrelated to the ward.

My thinking was this: I’d known for some time that I wanted to try something in public health. I could either throw myself into something fully in that field, or sort of hesitantly toe a line between that and the world I’d just come from.

Doing the latter would have been an unenthusiastic embrace of opportunity and would have left me with regret. With the choice I made, I know that I could go back to clinical medicine and feel assured that I’d really given public health a red hot go.

I’m a sucker (read: undisciplined) for trying to embrace too many interests at once. But having made this choice, I’m really starting to see the benefits of full immersion, and I’m glad I’ve fully immersed myself in this period of non-clinical work.

Principle 2 – I wanted to build new skills

I think there’s a relatively prevalent belief amongst health practitioners (and other onlookers) that a degree in medicine, nursing, or allied health is ultimately vocational, and that this makes an easy argument for not having concretely transferrable skills.

I think this couldn’t be further from the truth

In my mind, two of the most important clinical skills are history-taking and empathic communication – soft skills that are universally useful. I I think it would be reasonable to say that most problems are better solved when you’ve figured out exactly what the problem is, and that most relationships would run more smoothly if people felt listened to and on the same page.

Better yet, health practitioners have a unique opportunity to practice those skills: right there at the bedside, when the stakes of your conversation are the wellbeing or suffering of the patient in front of you.

Though we can claim to have these relative strengths, we must also claim our relative weaknesses.

For the most part, solving clinical problems is a case of identifying the right diagnosis from a list of known knowns, and marrying that up with an often pre-written treatment algorithm. There are, of course, exceptions, but I think this is a fair statement when you consider the vast majority of clinical practice — there’s a reason that we’re told that, “common things are common”, and that, “if it looks like a horse and sounds like a horse, it’s probably a horse (not a zebra).”

By contrast, a lot of non-clinical jobs – think of marketing and management consulting as examples – demand a more open-ended approach to solve problems that are often more open-ended still. The equivalent of history taking will help distill the problem at hand, but it may not be so obvious that an algorithm or evidence-based treatment line will be the solution. They can avoid the urgent specificity needed to treat the rapidly deteriorating patient.

I figured that learning how to approach things more open-endedly would be relevant to a career in public health and to grappling with large-scale issues of global health and the social and economic determinants of health more broadly.

So, this became a specific motivation: whatever I chose to do, I wanted it to force me to learn how to identify and solve open-ended problems.

Principle 3 – I wanted to do something exciting

I don’t think I prioritised this one enough, even if it has ended up being true.

It’s also perhaps the most important principle of the three, because, even if it is absolutely clear to you that you work to live and not live to work, it must be a burden on the soul to front up for something each day that you can’t raise the tiniest bit of excitement for.

If nothing else demonstrates my privilege, then that feeling surely must. But privilege is exactly what we have as health practitioners. We have the privilege of well-paid job security.

If you accept that truth and are considering a short trial of something non-clinical, I think it’s almost an obligation to yourself to find something that excites you, not just something that you can stomach. This is your chance to step back and say, “Hey. I’m here. I’ve got a license to practice. I’ll take my opportunities shaken, not just stirred.” Do something you’ve always wanted to do, do the thing you think you would do if you could restart and pick something other than medicine (or nursing or anything else).

Build undeniable proof of having chosen something so exciting so that, if you do return to clinical work, you can tell yourself that you not only gave it your all, but you gave it your all at the most exciting thing you could have done — the thing that would unquestionably compel you to continue it if you actually enjoyed it. Make it so that if ever or whenever you re-embrace clinical work, that you can do so with full and open arms and no sense of regret or resentment.

The proof in the pudding for me is this: that I wouldn’t have found my job or perhaps even been offered it if I hadn’t made a habit of choosing things that excite me:

• My choice of a career in global health came via an epiphany whilst actually excitedly chasing down a dream of being an astronaut.
• My current boss has said that the strongest part of my application wasn’t my medical degree, but the fact that I chased down an exciting opportunity to start a t-shirt company.

I’ve invested a huge amount of time and thought into both of these, but neither was a tick-box requirement for a career in medicine. At the time, I saw them as exciting side-plots. In the end, they have significantly (p<0.005) changed the course of my life.

I want to juice as much advice and wisdom as I can from the successes, mistakes and challenges of those experiences, so I’ll write about them separately.

Right alongside (and maybe even ahead of) my medical degree, they’re the things I’m most glad to have done, most grateful to have had the opportunity to be involved in, and most proud to have chased after.