Medical training and practice habituates physicians to a culture that narrows the possibilities we see for finding joy and meaning in our work. We often become efficient task completers, stuck in routines, and prone to burnout.  Saul and Stefan discuss a set of questions that challenge physicians to look at their work and themselves in fresh ways, can be used for mentoring or teaching purposes, as prompts for reflective writing exercises, or to engage thoughtful colleagues (perhaps over a beer). 

10 Questions (selected from On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients) 

1. Think about a brief account of a patient interaction you recently had in which you think you functioned as a healer rather than just a task completer – meaning that you were able to help the patient beyond the narrowly biomedical aspects of care? Was there something you learned from this visit that you could apply more broadly?
2. Think of interactions with patients that are rewarding and meaningful? Are they rare or common? Can you think of a specific one? Was there something you did differently that made the encounter memorable? If so, can you think of ways you could modify how you practice and interact with other patients so that more of your interactions are as satisfying?
3. Do you see yourself as someone friends turn to when they are in distress or need guidance? If so, what is it that you offer them that enables you to be such a valuable resource? Is that part of you accessible to your patients during medical encounters? Can you think of an example? If not, why do you think that is?
4. If you couldn’t be a physician, what would you most want to do instead? How would it be similar or different from what you have sought in a medical career? Can you draw connections between your second choice and medicine to gain perspective on what you most love to do? Assuming you stay in medicine, how can you be sure you are most likely to find it?
5. What’s happened to your curiosity during medical training? What are you more curious about? What are you less curious about? Specifically, what questions do you find yourself asking or wanting to ask as you go through the day? How do you think your curiosity or lack of curiosity affects how you relate to and care for your patients and how you feel about your work?
6. Do you feel your patients are benefiting from the distinct qualities that make you the unique person you are, or is that uniqueness not really a part of the way you relate to them? Do you feel you are interacting with patients in a manner that gives you a window into what makes each of them unique? Are many of your interactions rewarding? If so, in what ways?
7. Are there certain types of patients who “get under your skin,” making you cringe when you see their names on your appointment calendar? Consider what might be going on during your interactions with them, utilizing the framework described in this chapter. Is it that you can’t engage with them? Do you struggle with maintaining boundaries when they make incessant demands? How might you alter your behavior so that these encounters become opportunities to model healthy interaction and to provide them a brief respite from the chaos that is likely present in their other relationships?
8. Have you ever felt resentment that a patient didn’t show appreciation after you significantly helped them? If so, why do you think their show of gratitude is important to you? Does the doctor-patient relationship include an expectation that patients make their doctors feel good too? Could their indifference reduce your investment in their care? What if you learned from a patient’s family member that the person actually does appreciate you but just isn’t able to show it?
9. Given what you know now, do you think you can have a career in medicine in which you find patient interaction rewarding and meaningful much of the time? If yes, are you on course to experience those rewards, or do you need to make some changes? If the latter, what are you going to do to make those changes? Are you going to live with low expectations or look for something more rewarding?
10. Many, if not most, work environments have a fair amount of hassle, meaning you spend a good deal of time doing nuisance work and coping with difficult colleagues and bosses. These are manageable challenges, and they even provide an opportunity to learn to negotiate and adapt. Sometimes, however, workplaces become too dysfunctional to do your job effectively or facilitate meaningful change. They are beyond repair. How would you know when that line has been crossed? Have you experienced either or both of these situations? How did you respond? What did you learn?

Saul J. Weiner, MD; [email protected]