“If You Were Beginning Your Career . . .”

I am at the age when someone younger and unwary will ask me for my advice, more requested than followed, I am sure. Medical students and residents have asked me and many physicians this generic question in various forms: “If you were beginning your career, what advice would you give?” Although the focus of the question is on the respondent, the reply is for the questioner. Most who ask us for advice are unlined by age; they are also unfamiliar with Thoreau’s observation: “I have lived some thirty years on this planet, and I have yet to hear the first syllable of valuable or even earnest advice from my seniors” (Walden). I recall that when my daughter, Laura, then 16, helped in my office during my secretary’s vacation, she remarked incredulously after a couple of weeks, “Dad, people really come to you and actually pay you for your advice.” I reminded her that she could get my advice anytime at no charge. Perhaps if we parents did charge, our children would value our counsel more and heed it. The reality is that as E. W. noted, “A good scare is worth more to a man than good advice” (Country Town Sayings). Long before Freud, Samuel Johnson insight-fully recognized that “vanity is so frequently the apparent motive of advice, that we . . . summon our powers to oppose it without any very accurate inquiry whether it is right. It is sufficient that another is growing great in his own eyes at our expense, and assumes authority over us without our permission” (The Rambler, No. 87). That comment and my vanity not withstanding, like a determined surgeon, I will persevere unthwarted to give advice about a career in medicine, in plastic surgery. Readers will undoubtedly and hopefully improve upon my recommendations. I am not offering here a minimanual for attracting patients or running a practice. These considerations are important, but others are more so. Choose the Right Mate This is first on my list and not randomly. In my own life, I was fortunate in this regard. Others have not been. A happy life with someone who is not selfish, oppositional, or resentful is an asset, and together you form a basis on which to live a worthwhile life and build a successful career. I realize that, for many, an unhappy home can be the stimulus for finding gratification and solace in work and in professional achievements. Too often, however, the reverse occurs: unhappiness at home can breed unhappiness and failure at work. The reality is that one’s life at work and one’s life at home are inextricably linked; each influences the other negatively or positively. On the final day of my residency in plastic surgery at the University of Pittsburgh Medical Center, Dr. Dwight “Pete” Hanna commented, “Remember, plastic surgery is not everything in life.” Love has an important place and should not be relegated to inconsequential status. Marriage or any deep relationship is not a one-way street. My mother use to say, “Each should go toward each other 80 percent of the way.” When a plastic surgeon leaves the operating room he or she should leave behind the role of captain of the ship. If one is not careful in that regard, the marital ship will sink, taking along with it a career. Choose Something That Interests You The transcendental philosopher Ralph Waldo Emerson was right: “Nothing great was ever achieved without enthusiasm.” As a physician, one can help people and contribute to knowledge in any area of medicine. The choice must be what the young doctor truly wants. It is almost impossible to make the wrong decision if one follows one’s inclinations, passion, and skills. One should not decide on the basis of honoring the desires and expectations of others in preference to one’s own. Call your tune because you will have to dance to it for the rest of your life. Do not become unwittingly good at something you dislike to do, because you may be saddled with it until you retire and beyond. Choose a Direction Not Just for the Short Term It would be sad if a young doctor were to plan his or her life only in the context of the next 5 years without thinking about the next 30. Every medical student or resident should ask himself or herself, “If all goes well with my plans, what will my life be in two or three decades?” Though tempting, short-term gratification may be just that: gratification for now but not for later. There is more of later than there is of now. As a medical student, I recall the agony of having to choose among many areas of medicine, each with its distinctive appeal. After graduation the medical student becomes a resident in some specialty, even if it is called general practice, family medicine, or general surgery, and then, if he or she so chooses, plastic surgery. Within plastic surgery, subspecialization abounds. The resident completing training is totipotential; he or she can go in any direction, doing many kinds of procedures depending on interests and skills. The possible repertoire of a well-trained resident theoretically is broader, although not necessarily deeper, than that of his or her mentors, who, with time, have usually settled into a narrower range of doing perhaps a few or several kinds of operations but not every operation. I have never met a plastic surgeon who is equally skilled in dealing with every congenital anomaly, all head and neck cancer, every variety of micro-surgery, all aesthetic procedures, or hand operations, and doing noteworthy basic or clinical research. As far as I know, we have witnessed only one Michelangelo and only one Da Vinci. This does not mean that a plastic surgeon cannot have a few areas of competence and vary his or her time and energy in differing proportions during the course of a professional life. Seek a Challenge It would be myopic and wasteful for somebody young and beginning a career to avoid a difficult problem to embrace something simpler, albeit more lucrative. Discoveries generally are made by those who are young. At that age one is more energetic and should be more innovative and less indoctrinated, if his or her training has encouraged creativity and not demanded conformity. As wonderful as a mentor may be, no resident should be his or her clone. The older one becomes, the lower the tolerance for a complication and the less likely one will undertake a new procedure. The paradox is that one tries for years to do things right and to develop a routine, but that routine, though comfortable, may subtly stifle exploration because the surgeon fears taking a risk and facing failure. Do not be afraid to fail. Those who are seldom succeed in accomplishing anything significant. They retreat into Samedom, not a place anyone with an imagination should be. If one chooses to align himself or herself with an older plastic surgeon, be sure that he or she has the vision, capacity, generosity, and enthusiasm to let you develop your own direction and skills. In this regard I was fortunate to have been the younger associate of Dr. Joseph E. Murray. Do not become mired in private practice or in an academic environment that places quantity of patients treated against quality of care and permits no time for thinking innovatively about each patient. Making more money for a clinic, a hospital or a practice may result in not seeing patients who need our attention urgently, whose problems, if solved, would not only benefit those individuals but advance plastic surgery and medicine. Doing mindlessly what is known and safe is a prescription for arrested development. Do Not Overspend I am not an economist, but I have known many young people who have erred in over-committing themselves financially. Fiscal concerns are normal when one begins a career, but years later they should not burden you or dominate your thinking or distort your professional goals. If so, you have done and are doing something wrong. It is sad to spend one’s life trying to catch up with oneself! Keep Mentally and Physically Fit Even the supercredentialed physician is not superhuman. He or she can become tired, depressed with loss of equilibrium and perspective. Alcohol, drugs, and disruptions in core relationships may follow. The biblical injunction “Physician, heal thyself” might require a psychotherapist. Life is not a sprint but a marathon. In this regard, exercising obsessively in order to overwork will eventually be self-defeating. Excessive labor may lengthen your curriculum vitae but not your vita. I cannot end this Editorial without acknowledging the wisdom of Oscar Wilde, who had an opinion on almost everything: “I always pass on good advice. It is the only thing to do with it. It is never of any use to oneself” (An Ideal Husband, Act I). The following incident should humble any of us who teach the young. Several years ago, when I was a guest lecturer at a medical school on the West Coast, a doctor greeted me enthusiastically by saying, “You probably do not remember me but I was your medical student on your service and you gave me advice that I have never forgotten.” I was preparing to hear something brilliant that I had miraculously imparted. “You taught me, ” he said, “to shave twice a day.” Needless to say, I was surprised and baffled until he reminded me that in those days, when patients were admitted the night before an operation, I took the time to shave late in the day so that I would not look like a barbarian when I made evening rounds. So much for my legacy to the young!