As a physician, my ikigai has always been solid.
It’s an activity the world certainly needs and is willing to pay for. It’s also something I am skilled at doing. And, finally, because it was a chance to talk with and help interesting people every day, it’s something I usually enjoyed doing. It’s safe to say that being in clinical practice checked every ikigai box.
So, why did I change—especially towards a field which doesn’t automatically check every box?
Well, upon reflection, there were two forces at work: Something pushing me away, and something pulling me towards.
Pushing me away was the digitalization of medicine—specifically the advent of the electronic health record (commonly referred to as the EHR).
In theory (and in practice) EHRs can be quite useful. A digital representation of the patient can help with such things as continuity of care and record sharing. They can also allow for automation of healthcare reminders, decrease prescribing errors, and assist with complicated protocols. They also can make healthcare more efficient.
Ah, but that is the crux of the problem: efficiency. Efficiency is a word (perhaps the word) of the industrialist, the capitalist, the manufacturer, the investor.
It is the word of widgets, and assembly-lines, and assembly-line workers. It is not a word of humanity or kindness or caring. It is not a word that reflects the best of us.
To put it bluntly, for better and worse, EHRs are necessarily dehumanizing to both physician and patient. (Note: If you have been to a physician lately where he or she spends more time looking at a computer screen than you then you will know what I mean.) For most healthcare organizations (as an organization as “system”). patients are widgets and physicians are assembly-line workers and I didn’t want to spend the last decade or two of my life working on an assembly-line.
There was, however, an even stronger force at play: something was pulling me towards.
I have always been a clinical strong physician. I had sound clinical judgment, deep experience, and a good instinct for the outliers. I was confident in my abilities, and more importantly, I was aware of my weaknesses, and I knew when to ask for help. (my greatest limitation was I was overly conservative—not necessarily a bad quality in a physician). I would say I was a good, solid physician, but not necessarily a gifted one (I have worked with truly gifted physicians, and they are rare ducks).
But there was one area in which I did excel: creativity. My gift—well outside of my job description as a physician—was to look at our healthcare business from a radically different perspective. Where others saw weaknesses, I saw strengths; where others saw problems, I saw opportunities. Where others saw boxes, I saw hypercubes. Now, I wasn’t a particularly good leader or a particularly good follower, but I was an exceptionally good creative, and my contrarian, creative way of thinking was always my best quality as a business partner.
Unfortunately, just as this aspect of my skill set was on an upward trajectory, our clinic was purchased by a Fortune 500 company, and the last thing they wanted was a physician as a creative contrarian thinker. From out new ownerw perspective, I was a physician and my job was to see patients. Period. (See my comments on widgets and assembly-lines above!)
Now, I am not at all bitter about this. In fact, I am grateful, because as soon as I recognized it would be a constant struggle for me to be allowed to use my greatest strength within my organization (an excellent organization, filled with exceptional people, and one of the best in healthcare), it was only natural I look outside not just the company I worked for, but healthcare as an industry.
Simply put, I had a deep desire to use my best asset, my creativity, and for me, that wasn’t going to be found anywhere in healthcare.
It was time for an ikigai pivot.