I Became a Doctor to Help People: What If I Don’t Know How Anymore?

Last week, I asked how patients are supposed to believe we're committed to protecting their wellbeing when we can't protect our own. This week, I'm being pulled somewhere deeper: what does it even mean to be a doctor anymore?

That question came from a conversation with my colleague, obstetrician-gynecologist Luke Gatta, one of the most thoughtful ethicists I know. He was reflecting on a patient interaction he'd had with a medical student present. The patient wasn't in crisis. They weren't waiting on a procedure or a diagnosis. They were cold. They needed someone to change the room temperature.

What struck Luke was that the medical student seemed to weigh their own needs right alongside the patient's. Luke recalled thinking, quietly and with some devastation: But this has nothing to do with you.

He's right. And the longer I sit with that, the more it opens up.

Because here's what I keep coming back to: being a doctor involves high-tech procedures and cutting-edge therapies, yes. But at its most basic? Being a doctor is being a helper. Someone is sick in a hospital room, tangled up in IV lines and blankets, and they're cold. You change the temperature. That doesn't require a medical degree. It requires noticing that someone near you needs something (or is even suffering) and taking action.

I was a helper long before I was a doctor.

I loved running errands with my mom. I was the youngest-ever volunteer docent at the McKinley Museum in my hometown of Canton, OH. I candy-striped in high school (as all good students with medical school ambitions did back then). And then, after decades of training and more than $200,000 in debt, I joined what I'd been told was the helper-of-all-helpers profession.

I bought that identity readily. Eagerly, even.

It was easy to be a helper once, when communities were small, and the science of medicine was minimal. A calm demeanor in the face of hemorrhage after a tractor accident was therapeutic. Words that seemed wise during uncertainty were a salve. Simple presence at the bedside of the dying brought comfort to those grieving. The helping and the medicine were, more or less, the same thing.

But as medicine has gotten "better," helping has gotten much, much harder.

I think that's where the fracture is.

There's a concept, and I'll apologize in advance for bringing clinical language into what is otherwise a very human conversation, called identity fracture. It describes a state in which the parts of a person's internal sense of self become disconnected, usually as a way of coping with severe stress or even trauma. When we feel we can't bring our whole selves to a situation, we split: Self 1 into situation A, Self 2 into situation B. Self 3, 4, and 5 into C, D, and E, until we've divided ourselves so completely we can barely find the thread that connects our pieces.

It's a coping strategy. But it isn't a solution.

People living with fractured identities experience chronic self-criticism and imposter syndrome. They wear contradictory masks to gain acceptance in different rooms. They feel emotionally volatile because, without a stable internal anchor, every situation demands a different version of themselves. And underneath all of it: a quiet, persistent sense that they are living someone else's life.

Does any of that sound familiar?

I got into medicine to help people. I became an educator to help those who come after me. But somewhere inside the bureaucracy — the RVUs, the EMRs, the relentless back-and-forth about billing — I've lost the thread. I can't always just help anymore. Not the way I used to. Not the way that felt natural.

And what keeps me up at night isn't just my own fracture. It's the worry that I can no longer show the next generation what helping looks like. That the medical student in that cold room might not be failing to care, they might just never have seen it modeled. That the thing I took for granted about medicine, the identity beneath all the procedures and the message baskets and the paperwork, is no longer something we’re passing down intact.

I don't have a solution yet. I'm still working on what "new professionalism" even means. Maybe what needs to change isn't the definition. Maybe what needs to change is what we decide to protect.

More next week. In the meantime, please just keep helping. Even if it's just changing the room temperature.