General practice psychiatry

September 2013

Professional

A is for aphorism

‘Medicine is my lawful wife, and literature is my mistress. When I get [fed up with] one, I spend the night with the other.’

Volume 42, No.9, September 2013 Pages 663-664

Chee Koh

‘I feel more confident and more satisfied with myself when I reflect that I have two professions and not one. Medicine is my lawful wife, and literature is my mistress. When I get tired of one I spend the night with the other. Though it is irregular, it is less boring this way, and besides, neither of them loses anything through my infidelity.’

Such were the words of renowned Russian playwright and doctor, Anton Chekhov, in a letter written to his friend Alexei Suvorin on 11 September 1888. It is well known that many doctors pursue interests outside medicine. Anton Chekhov, for example, was perhaps better known for his work as a playwright rather than as a doctor.

So how common is this phenomenon of two-timing doctors?

With this question in mind, we shall distinguish the simple pursuit of after-work recreational activities from the pursuit of a hobby that requires a substantial investment of time and effort. This article will compare activities that require active participation and involvement with those that require passive or minimal effort. Essentially, we seek to elucidate the phenomenon of doctors who have, as Chekhov described, ‘two professions’. Consequently, excluded studies were those that sought to describe a doctor’s after-work recreational activities,1 such as television-watching patterns and preferred television shows,2 preferred genre of book in recreational reading, attendance of cinemas, etc.

Perhaps rather unsurprisingly, a literature search using appropriate keywords and MeSH terms in the PubMed database and several Australian medical journals revealed a lack of studies with good academic rigour in this area. The available publications are mostly limited to anecdotal evidence, casual surveys (where an emphasis on methodological quality is not priority) or the case study (or similar).

Nonetheless, there seemed to be a trend in the available literature. Participation in music appeared higher among doctors than other professions.3 The Australian Doctors’ Orchestra,4 whose members’ database of doctors actively performing as musicians number over 600,5 is one such Australian example. They take themselves rather seriously, holding regular concerts throughout the country and even secure corporate sponsorships.6 Indeed, doctor-musicians can be found all over the world, with examples in the United States,7 the United Kingdom8 and an internationally represented orchestra called the World Doctors’ Orchestra.9

Writing also appeared to be a popular pursuit among doctors who prefer liaisons outside medicine. The genres favoured by doctor-writers are as diverse as the doctors themselves: they span from fiction to non-fiction, medical thrillers to collections of real-life vignettes. Examples abound in publications such as magazines, newspapers and novels aimed at the medical profession, which frequently feature Australian doctor-writers. Novels not exclusively related to medicine have been published by authors including Dr Clive Fitts, Dr Richard Lovell10 and Dr Graeme Robertson (the latter published a series of books on cast-iron decoration of 19th century buildings in Melbourne).11 Other novelists of notable fame include American doctors Robin Cook (author of Outbreak) and Michael Crichton (author of Jurassic Park).

Is the allure of a ‘mistress’ strong enough to tempt a doctor away from his or her main profession – medicine? Studies of career intentions of doctors have aimed to provide an estimate. A British study showed the proportion of doctors 1 year after graduation indicating a preference to leave medicine for a non-medical career as a first preference at 1.4%.12

Does intention correlate well with the numbers who actually leave medicine?

The literature suggests that the number of doctors who actually leave medicine and seek a career outside medicine is hard to estimate precisely, given the lack of data and lack of response in surveys of such nature.13 One study sampled a cohort of doctors 18 years after graduation and found only 2% of doctors had left medicine. It is worth noting that, amongst those who had left medicine in this study, there seemed to be a greater number of doctors who were not in paid employment than those who were in non-medical employment.14 Reasons cited for leaving medicine, paradoxically, had not as much to do with love for a career outside medicine as for one’s dissatisfaction (or to quote Chekhov, ‘fed up’) with a career in medicine: poor job and career prospects, long and antisocial working hours, pay, and work dissatisfaction were commonly cited.15

Perhaps Chekhov was right after all: ‘medicine is my lawful wife and literature is my mistress. [I get tired of one I spend the night with the other]’, one becomes less bored, ‘and besides, neither of them loses anything’ through ‘infidelity’.

Competing interests: None.
Provenance and peer review: Commissioned; not peer reviewed

References

  1. Algra AM, Cleyndert L, Drenth JP. Cultural interests of doctors, accountants and lawyers: Art, culture and interface with the profession. Ned Tijdschra Geneeskd 2011;155:A4402.
  2. Crane M. Pop culture: No fluff, please, we’re doctors. Med Econ 2000;77:121–22.
  3. Nylenna M, Aasland OG, Falkum E. Survey of Norwegian doctors’ cultural activities. Lancet 1996;348:1692–94.
  4. Fraser C. Australian Doctors’ Orchestra: Mixing music and medicine. Med J Aust 2003;179:633–37.
  5. The Australian Doctors’ Orchestra [Internet]. Available at: www.ado.net.au/ ado/public/concerts/concerts.aspx? concert=2013A [Accessed 18 July 2013].
  6. Parliament of New South Wales [Internet]. Sydney: Parliament of New South Wales. Available at: www.parliament.nsw.gov.au/ prod/parlment/hansart.nsf/V3Key/ LC20111014003 [Accessed 24 July 2013].
  7. Ofri D. Thoughts on a G string. Lancet 2009;373:116–17.
  8. Lasserson M. Medicine and music – yet again. Br J Gen Pract 2004;54:475.
  9. World Doctors Orchestra [Internet]. Cleveland: World Doctors’ Orchestra. Available at: www.world-doctors-orchestra.org [Accessed 24 July 2013].
  10. Hurley TH. Doctors writing outside the square. Med J Aust 2011;194:87–89.
  11. Robertson EG. Victorian heritage: ornamental cast iron in architecture. Melbourne: Georgian House, 1960.
  12. Lambert TW, Goldacre MJ, Edwards C, Parkhouse J. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983. BMJ 1996;313:19–24.
  13. Goldacre MJ, Lambert TW, Davidson JM. Loss of British-trained doctors from the medical workforce in Great Britain. Med Educ 2001;35:337–44.
  14. Davidson JM, Lambert TW, Goldacre MJ. Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: Postal questionnaire survey. BMJ 1998;317:1425–28.
  15. Moss PJ, Lambert TW, Goldacre MJ, Lee P. Reasons for considering leaving UK medicine: questionnaire study of junior doctors’ comments. BMJ. 2004;329:1263.

Correspondence afp@racgp.org.au

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