The fourth-year medical student “Megan” urgently wanted to meet with me. She just returned from an away rotation in pathology in mid-August and wanted to talk. She was not her usual confident self, appearing distracted and pale. She shared that she had thoroughly enjoyed her rotation and had found it stimulating and the faculty inspiring. One of her responsibilities had been to meet with patients who had enrolled in a multi-year longitudinal study, which required regular, periodic blood samples. One well-educated and particularly savvy patient asked if he could be honest with her. He proceeded to tell her that she was not a pathologist. She was stunned. He went on to say that he had worked with many pathologists and students going into pathology, and she did not fit the mold. Megan enjoyed patients and had terrific interpersonal skills. He kindly urged her to put these skills to good use in a specialty with regular patient interactions, more so than what pathology offered.

Simply put, Megan’s boat was rocked. Her pathology residency application was complete, and she was waiting for the application portal to open so she could submit it. Now, however, she was rethinking her entire career.

Megan knew her patient was right, and part of her had been afraid to admit it. She knew direct patient care, in whatever field, could be messy, not black and white, and filled with lots of gray. Pathology seemed to offer more certainty. The patient made it clear to Megan that she possessed many gifts. On some deep level, she knew that she would not be fulfilled in her career unless she committed all of herself, which included compassionate, direct patient care.

Given the late date, it was a bit of a scramble, but Megan pulled it off. She was a strong student, and it was easy for her to discuss her change of heart with the authors of her letters of recommendation and explain her new direction. They gladly supported her. She matched into a clinical specialty and has had a fulfilling, successful, and rewarding career ever since.

So, what are the lessons learned from this story? There are a few.

Lesson #1: Medical students, like all of us, always have choices. We can change our minds, even in August of our fourth year of medical school, in residency, and after residency. The last thing we want to do is spend time in an endeavor that leaves us with regrets about what could have been. Specializing in a field to please others, whether it is to please an attending who is willing to write a nice letter of recommendation to please family or friends who have had certain expectations of us or to live up to a certain image we might have had about ourselves, is not a recipe for success. Sometimes this can be hard to see in the moment. With time, these realities become more apparent and can cause many more challenges down the road.

This leads us to lesson #2: We have responsibilities to others. Our job is to kindly help students, each other, and our patients find their own fulfilling, healthy paths. For instance, when we help students identify their passions and talents, we provide them, and their future patients and colleagues, a tremendous service. Information offered by the American College of Physicians for medical students and from other professional societies can provide much-needed insights when they are needed most. We can point to tools showing how to advocate for patients and our profession. We need such tools, our colleagues need them, and our students will too.

Which leads us to lesson #3: How do we know if a specialty, career path, or a residency program is the “right one?” A simple piece of advice shared with me years ago is, “Do you want what they have?” Another way to frame this, especially for students on the interview trail, is, “Do the residents and faculty represent the kind of doctor you hope to be someday?” Residency is an intense, formative experience. The residents and faculty we work with during residency will shape how we think and practice medicine for the rest of our careers. Now is the height of the residency interviewing season for fourth-year medical students. As much as students are interviewed by residents and faculty for residency positions, students are also interviewing them. Students, remember this: you have power.

Lesson #4: Be open to advice. Fortunately, Megan listened to her patient. Sometimes, patients provide the most honest and deepest insights. It is critical that we practice being open-minded because such guidance, whatever its source and wherever we are in our careers, may provide career or life-changing wisdom.

Lesson #5: Practice kindness and compassion. Megan’s patient did not have to share his observations with her, but he chose to do so. Made possible by his gentle honesty, kindness, and compassion, Megan’s career path changed, and all of us have benefited ever since. May we all boldly practice such kindness and compassion.

And lastly, lesson #6: Medicine is messy. Medicine is not black and white, and the way forward may not be obvious, or it may change. The lay public learned this acutely during the pandemic. In addition, advocacy is a necessity today, given today’s widespread dysfunction in health care and medical practice. Despite these challenges, Megan chose the messy path, as the rewards of caring for patients can be deeply fulfilling, satisfying, and enriching. It remains a privilege to be a physician. And for that, Megan is grateful, and so am I.

Janet A. Jokela, MD, MPH, ACP’s Treasurer 2022-2025, served as the Regional Dean of the University of Illinois College of Medicine-Urbana, and currently serves as Professor and Senior Associate Dean of Engagement at the Carle Illinois College of Medicine, Urbana, IL. 

The American College of Physicians is the largest medical specialty organization in the United States, boasting members in over 145 countries worldwide. ACP’s membership encompasses 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who utilize scientific knowledge and clinical expertise for diagnosing, treating, and providing compassionate care to adults, spanning from those in good health to individuals with complex illnesses. Stay connected with ACP on X @ACPIMPhysicians, Facebook, LinkedIn, and Instagram @acpimphysicians.