There was a time when my daily work meant sitting across from a patient in an exam room. I listened to symptoms, asked questions, performed physical examinations, ordered laboratory tests, tried to arrive at a diagnosis, and then prescribed medicine. Today, my world looks very different. The person sitting across from me has been replaced by a screen. Instead of examining patients, I examine datasets, clinical trial tables and listings, and safety reports. My stethoscope has been replaced by a spreadsheet. My physical examination has been replaced by filters, pivot tables, and increasingly long stretches of staring at rows. The patient is still there, of course, but I encounter them differently.
I am not the only physician whose career has moved away from traditional clinical practice. A nationwide U.S. longitudinal study of more than 700,000 physicians found that the annual rate of leaving clinical practice increased from 3.5 percent in 2013 to 4.9 percent in 2019. Behind those numbers are thousands of individual stories and one complicated question of identity.
For me, the transition raised a question I did not expect to struggle with. Am I still practicing medicine?
Medicine is not just a job you do. It shapes how you think, and even how you see the world. You hear someone cough in a grocery store and start constructing a differential diagnosis before anybody asks. Then one day, you realize you have not used a stethoscope in a while. There is no patient waiting in the next room. No family member is looking for an answer. For a while, that absence can feel unsettling. Your mind keeps asking whether stepping away from the bedside means stepping away from medicine itself. One day the realization comes that you are still making decisions that ultimately affect patients. It took me time to understand that I had simply moved to a different point in the process.
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Becoming a scientist changed more than where I work. It changed the way I think. I learned to ask different questions. What does the evidence show? Could what I am seeing be a coincidence? What am I missing? Is this a true pattern, or is it noise? How certain can we really be? What are the risks of acting on this information, and what are the risks of not acting? Can we look at the data one more time?
For a physician, the question is often, What is happening to this patient? For a scientist, the question becomes, What is happening across this population? One gives you the person. The other gives you the pattern. Neither view is complete by itself.
Clinical medicine teaches us to pay close attention to the individual. Science teaches us to step back and look across many individuals. One unusual laboratory result in a patient may mean very little by itself. The same finding appearing repeatedly across hundreds or thousands of patients may tell a very different story.
A spreadsheet may contain age, treatment, laboratory values, adverse events, and outcomes. Row 347 developed a rash. Row 812 had elevated liver enzymes. Row 1,204 discontinued treatment. It is very easy to scroll past them. But Row 347 is not a row. It is a person. Someone felt that rash. Someone waited for those liver results. Someone wondered whether the medication was helping or harming them. Someone may have called their family that evening and said, “The doctor found something.” That is the part I never want to forget.
Interestingly, the two worlds share something else: uncertainty. Medicine rarely gives us perfect certainty. Science rarely gives us perfect data. In both, decisions often must be made with incomplete information. As physicians, we may not know exactly why a patient is deteriorating when we have to decide what to do. As scientists, we may see a safety signal without yet knowing whether it is causal, coincidental, or part of a larger pattern. Both require judgment. Both require humility. And both require a phrase that is far harder to say than it sounds: “We don’t know yet.” I have come to understand that it is not a failure. Sometimes it is the most scientifically honest answer available. The responsibility is to recognize what we know, understand what we do not know, and keep asking questions that may eventually close that gap.
Becoming a scientist also made me appreciate physicians differently. Clinicians generate an extraordinary amount of information simply by listening, examining, diagnosing, prescribing, observing, and documenting. A clinical observation may begin with one physician noticing that something does not seem quite right. When similar observations accumulate, they can become evidence. That evidence can eventually change how we understand a disease, a treatment, or a risk far beyond the patient in whom it was first noticed.
Over time, I realized that my physician identity had not disappeared. It had expanded.
My perspective moved from one patient to many patients, from one clinical decision to evidence that may inform thousands of future decisions. Instead of only treating the illness in front of me, I now contribute to understanding the risks and benefits of treatments across populations. The scientist in me sees patterns. But the physician in me still sees the person behind them. I did not stop being a physician when I became a scientist. I simply learned another way to care for patients, including many I may never meet.
Riya Joshi is a pharmacovigilance scientist.
