Ok, I admit it, I am going through withdrawal and it’s hard!
I have been addicted to this drug for over 40 years. It soothed me, stressed me, shaped my days as I have structured my life around the addiction.
I am speaking of the addiction I have to the practice of medicine.
This week, I was wandering through the hospital on my way to lunch with a friend. Having gotten off on the wrong floor, I ran into my classmate, an orthopedic surgeon. We chatted for a bit as he discussed his “retirement” which involved working at least four half-days a week.
I have also run into other family doctors of my vintage who are hanging on to their small remaining cohorts of patients. In part this is because of the current insanity of the Quebec medical system, where they know that their patients are likely to be left orphaned and without primary care. But partially, I believe, it’s because of the reluctance to give up the dopamine rush of being a physician. Many doctors work into their 70s or 80s. Is it because they are dedicated to their patients? Have nothing better to do? Or are they addicted to the rush that practicing medicine can bring.
Michael Balint in his book The Doctor, his Patient, and the Illness, refers to the doctor-patient relationship as a therapeutic “drug” which is a major part of the cure. This is particularly true for those difficult to treat illnesses without a clear and simple diagnosis. What he does not address is how this relationship is also addictive for the physician. We get told every day how smart and caring and just plain wonderful we are. This seldom happens to people in real life.
I know this because I have a real life, with a husband, children, grandchildren, family and friends. Those are real relationships with complexities. Sometimes I am not my best self with them. Sometimes I hurt people I love, even as I struggle to love them well. My dear ones know me as a full person. They love me with all my flaws, and to them I am not flawless.
In the context of the clinical encounter, or even the teaching room, I can be the persona of the wonderful Dr. Feldman. This is a person who, while certainly not unlike me, is less complicated and nuanced. It is easy to be perfect at 20-minute intervals. For over 40 years I have wallowed in the feedback of being “the best doctor in the world.”
Since September 2025, when I stopped doing clinical work, I have sought other ways to get my fix of dopamine. My writing has always been a source of pleasure and satisfaction for me. So, I continue to write. I am trying to branch out and write for other publications. I am also in the process of attempting to collect my Medical Post stories into a book. I am doing more oral story telling and trying to create a storytelling group for medical professionals (let me know if you want to tell a story!). I am now able to exercise regularly and have been involved in fairly intensive Bubbie-work.
It is taking me a while, but I believe I am adapting. I honestly never want to do clinical medicine again. If I never have to read a new guideline it will be too soon, but I do miss the rush medicine used to give me. I miss my colleagues and students, the structured days that brought order to my ADHD brain. I miss the puzzles of diagnosis and the thrill of delivering a baby. I will have to work to replace this rush. Perhaps I can move to a more oxytocin-based type of pleasure, where the gentle satisfaction of crocheting a blanket or delivering home-cooked food to my chronically overworked children replaces the medical addiction.
It won’t be the same, but maybe that’s a good thing.