Just: A word that I’ve resented since leaving clinical medicine

Over the past few years, I have realized that I have come to resent the word “just.”  Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these days.  I am talking about using “just” as a qualifier.  As in, “Oh, I’m just the medical student,” or, “He’s just a nurse.”  We use it blatantly as an offense against others, and more overtly to undermine how we feel about ourselves.  That word has come to mean that in some way, you are not educated enough, not qualified enough, or not worthy enough.

It has been really interesting for me in the years since I left clinical medicine to pursue a decidedly non-traditional career path.  I mean, who finishes high school, college, medical school, and clinical residency and then eventually leaves the job they actually trained to do?  Here’s the secret about all that: your life experience is critical no matter what road you take. I have been extremely successful so far in developing my second career, and I would not be doing nearly as well as I am and getting the high-profile work I am without my past clinical experience. It gives me credibility, knowledge, and perspective that make what I have to offer unique.

What I have quickly come to realize though, is that while I am extremely comfortable with having taken on a new job identity, a lot of my colleagues are not. The “just” word gets batted around constantly.

“But aren’t you bored being just a consultant?”

“Isn’t it weird being just a freelancer instead of a doctor?”

First of all, I never stopped being a doctor.  There are thousands of us who have completed medical school and earned our MD degree (and many who finished clinical residency) who have taken detours to explore other areas of work.  Usually they are related in some way to medicine, but don’t necessarily involve direct patient care.  And guess what?  The MD Police have still not shown up at my door to take away my degree. The last time I checked, those two little letters after my name were still there.

Secondly, and perhaps this is the social justice beast in me rearing its ugly head, I can’t think of a single meaningful job that I would ever feel comfortable putting the word “just” in front of.  Think about what the act of gainful employment provides for us as individuals.  It gives us a sense of worth and need. It puts food on the table.  For some of us who are struggling with temptation, it keeps us honest and clean and helps us resist activities that might lead us to a place of total self-destruction.  Doctors in our current medical system would be virtually ineffective without nurses to actually put their plans into real action and physically take care of patients.  And just because you don’t like someone’s job or think that it is particularly challenging, imagine what your life would be like if the trash collector simply stopped coming to your house.  Not pretty.

I’ve been thinking a lot about “just” in the past couple of years since I switched my career horses in midstream.  Not because I’ve had to wrestle with it at all on a personal level.  I have more peace and joy in my career now than I can remember over the last decade.  It’s really more about the reaction it draws out of other people.  Usually it’s people who have made decisions for themselves that they don’t necessarily feel great about.  But for whatever reason, they feel compelled to stick with their decisions.  I tend to make these people really uncomfortable.  I think it may be because my decision to follow an unorthodox path and find my career happiness again forces them to examine their own decisions more closely.  And sometimes they don’t really like what they find.  Sometimes they are truly stuck because of financial obligations, and are miserable but just don’t see a way out.  I make them unhappy just by being me and feeling fulfilled and standing in the same room with them.  Sometimes people are stuck out of fear, and my lack of fear and my willingness to embrace risk-taking makes them feel bad about their own paralysis.  We are natural comparers as human beings.  We are always looking at what the other guy is doing, and constantly trying to see if we measure up.

Mostly though, it’s other physicians who have the hardest time with my decision to leave clinical medicine.  I think a lot of this has to do with the fact that there is a strong tradition of hard-won success in medicine.  The educational road to becoming a practicing doctor is very long and very hard.  For many people, there is also an enormous identity piece.  Some people are doctors 24/7. I don’t mean that they live in their offices and never go home.  I mean these are the people you will meet at a party (where there are no patients, no white coats, and everyone is drinking wine and eating little puffy hors d’oeuvres), and they will introduce themselves to you as “Dr. So-and-So”. I don’t have particularly strong opinions about whether this is appropriate or not, but it’s something I have never been able to relate to well.  I did not come out of the womb knowing I was going to be a doctor.  I am not one of those people who absolutely cannot imagine themselves doing any other profession.  (Clearly – I have imagined myself right into another line of work.)  For some people, being a doctor is the end-all of their identity, and they are not complete people without it and the respect and honor it deserves.  So these folks are the first ones to ask me how I can possibly be happy just being a consultant, when I could be a doctor?

I remember coming home from a conference a while ago where I had the opportunity to escape for lunch with a colleague who is a wonderful friend, and someone I don’t get to see as often as I would like.  We were having a very energetic conversation about all the work that lay ahead of us and how motivated we were to be doing it with committed and passionate people.  At one point, I was telling her about some of the new opportunities that had come up for me through the conference, as well as some exciting job opportunities at home, and the fact that I also have been committing time to writing, which has made me eternally happy.  I must have looked like some blissed-out kid who had just eaten an entire box of Twinkies (before the vomiting started anyway).  My friend looked at me for a long moment, paused, and simply said,

“My dear, clearly you were never meant to be just an MD.”

There it was, that “just” word again.  Except this time it had a completely different meaning.  It was obvious she hadn’t used it in the sense that being a physician is a lowly occupation, and I could certainly do something more quality with my life.  No, she meant it in the purest form of the word.  She was talking about scope and self-limitation.  Why only be an MD?  Why not use your skill set in new and unique ways to address issues of social injustice? It was such a pleasant shock for me to hear someone use that word in such a positive and fitting way, it was all I could do not to leap across the table and tackle her with a huge hug.

Betty Friedan, the famous early feminist trailblazer and author of The Feminine Mystique, once spoke about how different our lives would be if we simply knew early on that we were going to have three or four different careers throughout our lives.  If somehow that were the norm, how liberating it would be knowing that at any time, you could go ahead and start gaining the skills and education to do something new and exciting with your life.

I know just how she feels.

Lumi St. Claire is a physician and educational consultant who blogs at My White Coat Is On Fire.

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  • ninguem

    I know a guy from my internship days, he changed his first name to “Justin” for that year.

    Seems everyone called him “Justin Intern”.

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      Thank you for an awesome laugh! And hits all too close to home.

  • jsmith

    You have the right to do what you want with your life.

    But those in the infantry do not much respect paper pushers in the rear. Don’t expect them to.

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      Thank you for weighing in, although the fact that you would use a battle analogy to describe medical practice just illustrates even more how a clinical career these days is something to be “survived”, instead of something we could even hope to thrive on.

      • buzzkillerjsmith

        Indeed.

  • Suzi Q 38

    Saying “just” before a description of yourself or what you do for work is putting yourself down in a way.
    Let’s see:
    Just a doctor.
    Just a lawyer.
    Just a teacher.
    Just a mother.
    Just a SAHM.
    Just a father.

    I guess it is better than saying:
    “Just an a$$.” “Just a jerk.”

    I remember when a physician called me to apologize, in the hope that I would proceed with surgery at their hospital and not report him to patient advocacy.
    I was so angry, that I said something like this:

    “I can’t believe you are finally calling me.
    My letter to you about my health situation was over two months ago.
    It is a little late now. I can barely walk. Now I JUST don’t trust you. Do I have to teach YOU too??? Do I teach you by reporting you, or forgiving you and allowing you to learn from you stupid mistakes with me at my expense???
    I JUST don’t know which is the best way to go. Do I save other patients from doctors like you, or do I cut you a break because you are human and have worked so hard to get where you are today???
    You are JUST a specialist (gyn/oncologist). You are a horrible clinician.

    I think that you need to go back to medical school and try to remember what it was like to treat a patient with a whole body.”

    I realized that he was JUST a specialist, that he had allowed himself to think of patients illnesses in terms of only female organs and cancers.
    I was really expecting too much of him.

    Just. It is kind of a condescending word, one that I did not like using.

    I congratulate you for actually doing what you want to do with your life.

  • Suzi Q 38

    I think you know that you don’t have to be a physician if you don’t want to be.
    The mother of one of my daughter’s friends started out as a dentist.
    she said that she realized early on that she did not like putting her hands in people’s mouths, LOL.
    She decided to “switch gears” and become a lawyer.
    She used her dental knowledge not in malpractice cases, but to litigate dentists in partnerships that they wanted to dissolve. A professional legal separation and “divorce” if you will.

    She told me: ‘JUST like marriages, the business partnerships sound like good ideas. Sometimes, the parties “jump in” without legal representation or written agreements. Many times, like marriages, they are so much easier to get into than out of.”
    This is how she earns her living. At something she is trained to do, yet help in a different way.

    She makes far more than her first profession paid, an the dental “infantry” not only respect, but they call her.

  • Suzi Q 38

    Frank H. Netter M.D. started out as an artist, but his family did not approve.
    To please them, he did something more respectable. He became a physician. When he was ready to practice medicine, it was the 1930′s and the Great Depression provided few paying patients. He started selling art in the form of drawings of the human anatomy to supplement his income.
    One thing led to another, and soon the art income exceeded the income he made as a physician. He worked for a major pharmaceutical company named CIBA-Geigy, who commissioned him to draw many pictures of the human anatomy and various medical conditions.

    The pictures, bound in books, were very popular in their day.

    He was able to quit medicine.

  • http://www.facebook.com/survivor.do Survivor DO

    I must say, sometimes it’s nice to be “just” an intern and the lowered expectations that come with it, makes it much easier to surpass them!

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      That’s because you live in the real world, and your learning curve is straight up, which is appropriate. :)

  • http://twitter.com/gcgeraci Gaspere (Gus) Geraci

    I enjoyed the thoughts. One the one hand, the battle analogies, and the other, the subtle “put-down” use of the word just implies. And finally, the twist of the meaning – the implied limit to the word just, something that you can grow beyond. and whether that limit is an insult. For that ambiguity, I, too, dislike just. IMHO, we should be what we want to be, and should grow and always add to what that we may be transiently defined as. Intern, Dentist, doctor, or artist. We add to our identities, never subtract. Except for a specific purpose, where you want to define your limits (I’m just an intern) we always carry forward what we are and have been, and shouldn’t define ourselves by just one term or word like just.

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      Thank you for sharing your thoughts – I love the concept of “adding to our identities”! And it’s true – sometimes you WANT to use the word just in a defining way that sets limits, which I’m all for. It’s when it starts turning into a blanket definition that automatically means limits is when things get out of control.

  • StephenModesto

    I appreciated the thoughtfulness of your reflected self-disclosure. Is it just me?…many of the comments posted seem to be reading merely the literalness of your storied social assessment of culture, achievement and aspiration. Between the lines I am sensing you sharing the experience of the process within the theme of `Being and Becoming’.

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