Seeking mastery in medicine

acp new logoA guest column by the American College of Physicians, exclusive to

Regardless of specialty, medical practice is challenging in today’s health care landscape.

Increasing demands related to workload and job inefficiencies, an ever-increasing administrative burden, the consuming nature of health information technology, and personal and professional values that often conflict with the expectations of the health care system have severely negatively impacted the perceived effectiveness and happiness of many physicians and led to a crisis of burnout among doctors.  Many of my colleagues express a deep-seated sense of powerlessness against many of these aspects of the health care environment over which they have little control, and this only contributes further to the moral injury they are experiencing.

But I believe there are things we can do as individuals to actively overcome this sense of powerlessness and seek to recapture the meaning and joy in our professional lives.

In his book Drive, Daniel Pink observes that humans are inherently motivated by three things – purpose, autonomy, and mastery – these are the essential elements needed to find meaning and reward in the work we do.  These factors certainly apply to physicians as well and are a helpful lens through which to view our professional lives and possibly provide a pathway forward in combating burnout and reclaiming the personal satisfaction that should result from the practice of medicine.

Purpose is the desire to do something that is personally meaningful in our life’s work, and is something we all possess as physicians.  A deep belief in and commitment to the foundational principles of medicine are what compelled most of us to put forth the time, effort, and personal sacrifice needed to become a doctor.  And despite the barriers the current health care system may place in the way of our living out these core principles, they continue to serve as a primary motivating force for what we do; reminding ourselves of our foundational purpose as physicians is always important when confronting the many frustrations encountered in daily practice.

Autonomy, or the desire to be self-directed, is a bit more problematic.  Structural and administrative changes in today’s health care environment have markedly decreased the level of control that physicians had in the past and diminished our ability to effectively self-manage our daily work.  Although it sometimes feels as though there is little we can do as individuals to affect this aspect of our professional lives, it is this area in which the collective voice of physicians is likely to have the greatest impact in countering this loss of autonomy, and something with which we all need to participate.

But it is the concept of mastery that seems to hold the greatest promise in helping us push back against the loss of joy and satisfaction that many of us experience in medical practice today.

Mastery is defined as the possession or display of great skill, technique, or comprehensive knowledge in a subject.  Seeking mastery, therefore, is simply attempting to get better at doing what we do.  But how can pursuing mastery in medicine help us as individuals, and what might doing so look like in our daily lives?

Each of us has navigated the long and challenging road to becoming a doctor, and consequently accumulated an expansive fund of knowledge and set of specialized skills that allow us to care for patients.  We have each spent years and tremendous effort developing and cultivating these skills, and in doing so, they have become an integral part of who we are as individuals and form the basis of our personal and collective identity as physicians.  And because they are so key to who we are and what we do, no amount of dysfunction in the health care system around us can diminish them or the values upon which they were built.  Although it is easy to neglect or undervalue the significance of these tools of our craft in the course of our busy professional lives, I believe that by reconnecting with and focusing on the foundational principles of medicine (our purpose) and those unique skills that allow us to function as physicians by seeking mastery in our work, we can not only reaffirm our personal identity but also reclaim the satisfaction inherent in our role as caregivers.

Working toward mastery begins with creating a mindset and approach to our daily activities that extend beyond the routines of patient care and manifest as a true desire to personally improve our abilities in both the science and art of medicine, with the expressed goal of seeking to be the best physician we can be.

It requires that we pay close attention to what we actually do in our clinical work, and that we practice deliberately, meaning that we actively and intentionally seek to improve the skills we already have, but also push ourselves to extend the range of our skills even if this moves us into areas beyond our current level of comfort and competence.  And it involves the hard and often painful process of honest self-assessment and a willingness to change based upon what we find.

In practice, it may involve expanding what we know by seeking out knowledge beyond our area of practice focus and attempting to become facile in related fields.  It may be honing our diagnostic abilities through refinement of our history gathering, physical examination, and diagnostic reasoning skills, including incorporating new technologies and approaches into practice.  It may involve close examination and analysis of our clinical management skills, including how we prioritize diagnostic and therapeutic interventions for individual patients and coordinate care with other health care professionals. It may involve careful and thoughtful analysis of our own patient cases and clinical outcomes, good and bad.  And it may require examination of the nature of our therapeutic relationships with patients and how we manifest humanism and the principles of physicianship in our daily practice.  In other words, pursuing mastery is focusing on further developing and refining those things that led us to become physicians in the first place.

Seeking mastery in medicine should be a journey of self-growth that is more about the journey itself rather than achieving a particular destination, but one that will hopefully be an avenue to recapturing the enthusiasm and passion for medicine that most of us have inside.

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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