The first time I heard the phrase “shoulding all over yourself,” I laughed. As a gastroenterologist, I have a particular affinity for poop jokes. It might not be obvious when you read the phrase, but say it out loud, and you will hear it. I think the phrase also caught me off guard. I didn’t understand the significance of the word should. It just seemed like an ordinary word in the English language—nothing to see here. Just keep scrolling. Upon closer examination, I discovered that this six-letter word does more damage than most of the four-letter words we try so hard to avoid. The word should is riddled with expectation. It is often wielded like a weapon against ourselves or someone else. The use of this word amongst physicians is ubiquitous and relentless.

I want to blame the abundance of physicians shoulding themselves on our medical training, but it typically starts way before we ever step foot in a hospital. It begins with us. I frequently skipped fun social events in high school and college because “I should be studying.” The expectation that I needed to excel in school so that I could someday become a doctor didn’t start with someone else. It started with me. And those self-imposed expectations may have been the kindling, but my medical training was the blow torch that lit the wildfire.

Since I am speaking to “my people,” I don’t have to explain the expectations placed upon us during medical training. As the ancient adage popularized by Uncle Ben in Spider-Man goes, “With great power comes great responsibility.” Each step in our training is filled with expectations and things we are supposed to do. It makes perfect sense. There are so many important lessons to learn. There are skills that need to be mastered. People’s lives are at stake, and we took an oath: “First, do no harm.” So we do it. We heed all of the expectations. We become experts in our respective specialties and get released into the world. However, in the process, it is not only medical knowledge imparted upon us. We are also indoctrinated into the expectations of medicine. And boy, are there expectations:

• You should sign all of your charts in a timely manner.
• You should make sure that every chart note is perfect.
• You should always get high patient satisfaction scores.
• You should add one more patient every day to improve your numbers.
• You should be a leader.
• You should join a committee.
• You should start clinic early or stay late.
• You should stay up to date on every new journal article.
• You should recertify for all of your board exams.
• You should publish more.
• You should teach more.
• And the list goes on and on.

Unfortunately, the shoulding doesn’t end when you exit the hospital. People have a lot of opinions about what you should do in your personal life. Thinking about early retirement or going part-time?

“You went through all of that training and took a spot from someone that really wanted to be a physician. You shouldn’t do that.”

What exactly is my obligation to medicine? Am I supposed to practice medicine forever? Is it my duty? Do I have to continue serving my patients, the hospital, and society because of these expectations?

The answer is simple: You get to decide. Most physicians I know love practicing medicine. It is and has always been a calling. The problem lies only in the thought that you should practice medicine. When used in this way, the word should is a cognitive distortion. A cognitive distortion is a pattern of thinking that is generally false or inaccurate and carries the potential to cause psychological harm. When you use the word should, there is often an accompanying shift in focus from what you want to what others might think. In other words:

“If I go part-time, my partners will think I am lazy and not dedicated, so I should keep working full-time.”

But who defines full-time? Who determines what is enough? What if sixty hours of doctoring per week isn’t enough? You are technically always a trained physician, so maybe you should work 24 hours a day, seven days a week, and never get a day off. Would that be enough? The truth is that physicians have difficulty knowing when we have reached enough. We get on the hamster wheel of achievement early in life and start running. We are running so fast that we forget to stop and ask ourselves what we truly want in life. Once you know what you truly want in life, the “shoulds” matter a whole lot less.

Expectations of physicians and our time are omnipresent in today’s health care landscape. Most of the time, we accept these expectations. There are expectations about when our clinic should start and end, how long it should take to respond to an InBasket or patient portal message, and how we should adjust our practice to respond to the latest metric handed down from above. The power in each of these scenarios is remembering your ability to choose. Your strength lies in knowing that you make those choices because they are authentic to the person, physician, parent, spouse, and child you want to be. You don’t do these things because you should. You do them because you want to do them. And maybe there are some things you don’t want to do. Perhaps the thought of going part-time or retiring early from medicine is appealing to you. What will other people think? Should you care what they think? Will it matter what they think when you are living a life you love?

In the end, all that matters is what you think. What is your “why?” What gives you purpose and meaning? What drives you throughout your day? Others are free to have their opinions. You never need to concern yourself with that. You get to do whatever you want, and they get to do the same. Their expectations of you do not control you. There is no should. There is no correct answer. Figure out what lights you up and do it. We only have so much time here, and the clock keeps ticking. Don’t look back on your life only to realize that you were so worried about what other people might say that you forgot to think about your needs and wants. We only have one life. Don’t wait to make it great.

Michael Hersh is a gastroenterologist. 

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