I love what I do. Being a doctor challenges me every day to think critically and creatively, to learn new things, and to make the vast machine that is the American medical system run smoothly. The relationships I've formed provide me great power to do good: my patients trust me like no one else in their lives, which gives me enormous influence over their decisions (which, of course, also provides equal opportunity to do harm).

I've witnessed moving dramas, seen people rise to greatness they didn't know they had in them, and enjoyed idiosyncrasies so outrageous I couldn't have invented them in my wildest imagination. Though many people think doctors routinely save lives, in my field, internal medicine, that happens only rarely. Most of my time is spent managing chronic illnesses and minimizing future risks. Occasionally I do make an astute diagnosis no one else has been able to make or catch a critical lab value no one else has thought to check, but mostly I just talk to people about what's bothering them and try to make them feel better. And it's enormously gratifying.

But there's a lot to dislike about my job as well. The amount of paperwork I'm required to complete is enormous. The system in which I work is inefficient and overburdened, often requiring me to become involved in far too many non-medical tasks, like calling in favors with colleagues to get patients seen or even scheduled for tests. I often don't have enough time to spend with patients who need it (I spend it anyway and suffer the consequences of being late to meetings or falling behind in returning phone calls or answering emails or getting enough exercise). Important services for patients are becoming scarcer: I dread sending anyone to the ER where the wait is often on the order of 10-15 hours for urgent (but non-emergent) care. Insurance coverage for mental health care is embarrassingly inadequate in many, if not most plans, and especially in Medicaid which serves a population often more in need of it than any other group. In fact, some surveys have shown almost 50% of primary care physicians are dissatisfied with their careers and would quit if presented a viable alternative.

Not me, though. I am often frustrated and the field of medicine is obviously going through enormous upheaval right now. But not only am I profoundly grateful I have a job (given how many people currently don't), I recognize that no job involves doing only the part that drew us to it in the first place. Any and all dream jobs we could imagine will always have peripheral parts to them that support the exciting, central part but which we almost certainly won't enjoy.

But the real reason no job can ever be perfect is because we won't ever be perfect. We'll always have a constantly shifting life-condition that makes today seem awful even though yesterday we felt great doing the exact same thing; we'll always keep making new mistakes; we'll always on occasion fail in a big way; and we'll never be able avoid having others dislike our work.

It would be terrific if something in our lives were only and always good. But nothing in my life---even the most cherished parts of it---is only wonderful. I'll confess here that sometimes, even though I love him to pieces, I find my son boring (think about what a 20-month-old likes to spend his time doing...). My great passion, writing, is hard work, and though I don't begrudge the effort, to enjoy the success I dream about will require me to do several things I'd prefer not to do-marketing myself and my work chief among them. But I will do them. Because I recognize that to believe that anything in life---even something we love---could ever be only and always good is to believe the fantasy of a child. And because having to work hard to accomplish something provides two benefits: the goal itself and the satisfaction of having had to work for it.

If you enjoyed this post, please feel free to explore Dr. Lickerman's home page, Happiness in this World.

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