Why? A personal reflection on becoming a family physician.

I went to medical school mainly because it was the hardest course to get into and carried the greatest prestige. I entered as an intellectual snob but quickly found out that medical school in Scotland in the 1960s required taking risks, putting up with a lot of stuff, and working hard! I enjoyed all clinical courses, but the most intense competition was for the professorial surgical internships. Naturally, I became one of only two female surgical houseofficers—we really did live in the hospital! My attending forthrightly stated that my appointment was a mistake by the mysterious selection process, and a waste of a career-building opportunity for a (male) surgeon. I was determined to impress, but the work quickly sublimated the motivation to placate distinguished but tyrannical bosses. We were the best surgical unit anywhere. We took acute and referral cases from a wide area and were regularly swamped with highly complex admissions. Houseofficers quickly became adept at assessing patients and lining up the data to present a tidy case to superiors. We were skillful negotiators with anesthetists, operating room personnel, porters, lab technicians, and multiple others in a complex and precariously balanced barter system. As soon as an attending decreed he would operate or needed a specific investigation or treatment, we could make it happen. The work was grueling, but we were intensely proud of being part of the professorial team. We lived on caffeine and adrenaline, cocky and confident young physicians who (almost) believed our team could fix anything. One night we admitted a man who was asymptomatic but deeply jaundiced. At laparotomy his pancreatic cancer was so advanced that the Chief only attempted a biliary drainage procedure and closed the abdomen. His silent fury and frustration left everyone depressed and helpless. I was told to “call the GP and discharge the patient home.” The GP, an elderly doctor in a small town, was not surprised by the situation and was surprisingly pragmatic. As I poured out the details, he kept repeating “OK, I’ll deal with that.” Finally, I wailed, “But it’s hopeless, he’s going to die.” “I know,” he replied, “but my job is to ensure he dies well. I’ve been his doctor for a while, and I owe him this.” He talked calmly about pain and symptom control and the patient’s family—he knew all kinds of details, including that the patient’s daughter was planning to be married in a few months “so we should see if they can bring the wedding forward.” He was under no illusions about how demanding and difficult the task would be, but he was prepared to guide and support the patient and family through the experience. I felt foolish. In my world, the interesting patients were prioritized by the uniqueness of their pathology or the technical challenges they presented for surgical intervention. I was jealous of the GP’s relationship with his patient and in awe of his calm determination to manage this case for which our world-class unit had “nothing more to offer.” I wanted to be someone’s doctor instead of the slickest houseofficer in the Royal Infirmary. This experience started a process of reflection on my motivations and needs in my professional life. Being challenged, busy, and making a difference were obvious. I realized that my favorite time had become as the wards settled down for the night. Checking things with the incoming night nurses had started as a smart move to minimize calls that disrupted sleep, but late evenings provided an opportunity to talk to patients without the pressures of the day. Discussions about symptoms or plans for tests or treatments were more honest and productive in the quiet evening wards. I was increasingly interested in how patients had become aware of their conditions, what they thought was going on, and what might happen after the hospitalization. I was too curious, or too selfish, to be content with being involved