I woke up this morning vividly remembering my dream. I’m sure I dream often, but they are generally lost to the subconscious – never to be known. Today was different, and I’m still teary-bleary eyed as I type this.

In my dream, I was visiting with a young doctor who was contemplating going to work at the same place I had started my career. She was seeking advice on whether or not she was making the right decision. I paused and reflected before I answered her, and then passionately laid out how my dissatisfaction began to arise from having too many conflicting tasks. More importantly, I had conflicting tasks that took me away from what should have been the most immediate priority of caring for my patients. And at the time, most of my patients were hospitalized children – an especially vulnerable population.

Ultimately, the inner conflict of knowing what I personally and professionally needed to be doing versus the work I was mandated to perform led to an irreconcilable internal crisis. I would either compromise my values to maintain the status quo or I would have to move on. Being no one’s water boy, it was time to move on. My advice to the young doctor was to stand up for herself, and for what she knew to be right if that conflict ever visited her. And then I woke up.  I grabbed my coffee and stared into the mirror at the lines in my face and the gray in my beard.  I wish someone had told me the words I shared with that young, imaginary doctor.  I might have been less tolerant of the conflicts I faced and been more decisive in my actions.  As it is, I’m doing the right things, just further down the road than I had hoped.

And as I stare at middle-aged me in the mirror, I am once again at the precipice of a new beginning.  Once again, the conflicts arose, pitting idealistic me against the realities of modern healthcare.  I am not alone, as talk of burn out is all the rage in medicine these days.  Many of my immediate colleagues move on to other patient care venues, while across the country, hundreds, and ultimately thousands, of physicians will be leaving medicine entirely.  I’m somewhere in the middle, as my new career remains in healthcare, but I will no longer be at the bedside caring directly for patients.  It turns out one of the biggest casualties of burn out is one’s own sense of remorse, as I cannot help but find myself eager and excited to move on and start healing my soul.  I could either keep sacrificing my dignity and purpose to the gods of medical administration, or I could take a chance on myself and begin anew.  In the end, is this a choice at all?

Many of you reading have probably never thought about the business of medicine. Well, the dirty little secret is that most doctors also aren’t well-educated in the business of medicine either. In fact, we bristle at the notion of calling it a business. We simply finish residency and then go to work, trusting in the end that we somehow made a good investment in ourselves to take on crazy debt in pursuit of a calling. And for the vast majority of physicians, it is a calling. I know I never sat down to determine if it was a good investment – it was just what I had to do – no matter what the personal cost. And the personal costs – emotional, spiritual, and financial – were very high.

So here I am, now 19 years out of medical school, and I’m starting over.  Not because I am any less passionate about caring for the sick, but precisely because of how passionate I am.  You see, the other dirty little secret is that nearly all our education is in the treatment of disease.  We spend countless hours learning about infectious diseases and cancer and heart disease and strokes and dementia and on and on and on.  We piece together the symptoms of our patient with their physical exam and labs and x-rays and give them a diagnosis.  Then we deploy our other greatest expertise to treat them – drugs.  If I had to put a number on it, about 95% of our education centered on Diseases and Drugs.

The overwhelming focus of my career (and those of my peers as well) has been the diagnosis and treatment of disease.  I performed these services in the confines of systems that need sick people to stay in business.  Without disease, the doors could never stay open.  And this is the ultimate paradox in healthcare.  Early in our careers, we young doctors would often say to ourselves that we are the only profession that altruistically wants to put itself out of business.  Middle-aged me now admits this is far from the truth.  Medicine is big business, and sick patients keep healthcare dollars flowing.  Sad, but oh so true.

It is in this context  that my wife and I started a journey this year born out of our own medical nightmares.  We are both doing well, but have been awakened to how ignorant we were of what it actually means to have and maintain HEALTH.  I’ve often said the most dangerous doctor is the one who has no idea what he doesn’t know, and here I was realizing I had a blind spot in what it takes be healthy and to actually compel patients to take non-pharmacologic actions to improve or even eliminate their own disease.  The insights we continue gaining to improve the health of ourselves and others is far more motivating than the diagnosis and treatment disease.  And while we can never prevent and fully stamp out all disease, it certainly seems like a better goal than just putting up with disease to keep the doors of our clinics and hospitals open.  More on all of this later!

This is the start of what I’m calling The 46 Project.  I like projects, as defining methods and goals is far more practical than the nebulous notion of just wanting to be a better, more loving, healthier person.  I haven’t really started a project I was intimately passionate about since college.  In fact, the last real project I completed was accomplishing everything it took to get in to medical school.  Huh.  Weird.  I’ll also be revealing some other tangential projects as I go along.  I have suppressed and suppressed long enough, and some ideas just won’t die in my mind and need a chance to be born.

Most people would look at the family, career and possessions I have at age 46 and think, “That guy has it all!”  And they’d largely be right.  I have a wonderful family and I’ve done a lot of good in caring for patients, but I have also spent too much time on the acquisition of things (and the resultant time and cost of maintaining these things) and have been too willing to go with the flow to avoid conflict.  If I’m brutally honest, I’m also pretty damn frustrated at how I physically feel at this inflection point.  The lack of time I’ve dedicated to self-care is a reflection of my own misplaced priorities.  I have built little in terms of lasting legacy, and I know quite well I’m capable of doing a great deal more than just treating one diseased patient at a time.  So, The 46 Project begins.