'What's my Motivation?' Radiologist, Know Thyself

Half a lifetime ago, I dabbled in acting. Some family members, much later, confessed that they worried I would be successful and that it could potentially steer me away from a career in medicine.

I took drama classes for a couple of years and performed onstage a handful of times. Before pre-med (and then actual med school) derailed all of that, I learned a bit about Method acting and the like, some of which is passingly familiar even to folks who have never done it.

You have probably, for instance, seen comedic poking at actors, especially self-important ones, demanding to know "what's my motivation" for doing the pettiest things onstage. The legit underpinning is that one doesn't look genuine if one simply goes on stage, recites some memorized words, and stands/walks where he or she is told. One is supposed to internally become one's character, whose actions, just like those of real people, have underlying motivations.

Outside of acting, we examine motives plenty but usually in trying to figure out other folks. This is for all sorts of purposes, whether it is claiming to know what a political figure wants, or why she or he did something, or gaining a better of understanding business and social contacts. In therapy, we are even supposed to get a better handle on our own motivations.

Such self-reflection, I believe, should probably occur more regularly without needing a guiding hand from mental-health professionals. A lot of life's dissatisfactions could be corrected, if not prevented. That is especially the case for strongly motivated, goal-oriented types like physicians (yes, including radiologists).

This seems backwards, doesn't it? If someone's motivations are strong enough to get him or her to slog through all of the schooling and post-grad training that's required of a doc, surely, they don't need to question themselves.

I consider such deep-seated motivation to be just as much of a potential liability as it is a strength. People grow and change. Experiencing various stages of life has a way of altering your outlook. Think about your opinions, behaviors, and overall worldview from a couple of decades ago. Your motivations might well have shifted.

However, if you are driven and goal-oriented enough to pursue and keep a medical career, you may have just considered your motivations toward it etched in the bedrock of your soul. You just plowed along without ever questioning them. After all, that could be hazardous to your mission: What if you looked within and made some deep discoveries that weakened your commitment to the path you chose long ago?

(The answer, of course, might be "Good! Go do something else with your life if it suits you better." But if your sense of self is so wrapped up in being a physician, such thoughts might seem self-destructive and avoided at all costs.)

Dismissing such drastic notions as docs who might not truly want to be in their field, there is still plenty of room for misunderstood motivations and the harm they can do. A good example, and a bit of the inspiration for today's blog, is a question pretty much any student has to answer when applying to med school: Why do you want to be a doctor?

Applicants generally know to offer answers that might not be the entire truth in the name of scoring points in the eyes of their interviewers. "I want to help people" is a trite one. Meanwhile, I vaguely recall a movie about med students from the 80s or 90s in which one of the main characters had the bald-faced assertion: "I wanna make a lot of money."

It seems more than a little possible that some folks, having become practicing doctors, pretended so often not to care about the financial rewards of a medical career that they actually brainwashed themselves, or assumed the burden of "helping people" for excessive shifts, nights, and weekends at the expense of maintaining a personal life.

That doesn't, however, make their underlying motivations go away and one doesn't need a psych degree to know that "living a lie" results in fertile ground for dissatisfactions to bubble to the surface in all sorts of ways. This may include casting aspersions on colleagues who are more willing to admit enjoying a decent lifestyle, considering their medical work as a job rather than a holy mission.

Having a full life (working long hours, keeping up with family, friends, and extracurricular activities), one might not spend much time meditating or in deep introspection. Occasionally sitting down and thinking deeply about who you are, where you're at, and where you want to go isn't something that automatically happens. I believe in making time for it but to each their own.

If you don't examine your motivations but would rather not risk plugging along with unsatisfied inner motivations until you have a midlife crisis (or living in vague unhappiness for the long haul), I have noticed a cheap "hack" for such soul-searching. To put it simply, think of situations where you would do one thing if your primary motivation were A, but another thing if it were B. (Alternatively, stay alert for actual situations as they come up, and notice whether what you do is what you really wanted to do.)

You might find, for instance, that you value lifestyle more than wealth. Perhaps you took a job with fewer weekend shifts in exchange for lower salary. On the flip side, maybe you regret taking a higher-paying gig when you thought money was your big motivation but now you miss your weekends. Alternately, perhaps you value intellectual satisfaction over helping people (spending fifteen minutes really digging into a complex case rather than burning through the entire list of ICU x-rays to get the team all caught up when somebody else might have handled the tough scan more easily).

Of course, we're complex creatures, and probably none of us have one overriding motivation to the exclusion of all others. Most, with enough thought, could probably come up with a ranked list of their top five, even 10 motivations. If #1 isn't all that far ahead of the others, it's probably worthwhile keeping tabs on how you're satisfying them all as well as whether #2 might gradually be moving ahead to take the lead in the next few years.