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Born: San Francisco, California
BA Yale University (American Studies)
MD University of California @ San Francisco
Neurology Residency University of California @ San Francisco (UCSF)
Board-Certified in Neurology American Board Psychiatry and Neurology
Former Chief, Division of Neurology UCSF-Mt. Zion Hosptal
Former Associate Chief, Department of Neurosciences UCSF-Mt. Zion Hospital

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A Personal Comment (from a 1999 Salon.com article)

Question from a Salon.com reader:

"I just stumbled onto your column last week and found it to be very interesting and well-written. My question to you is not so much a professional question as it is a "question of profession."

Ever since I was in high school, I have been torn between two different fields: writing fiction and becoming a doctor. Can you see where this is going? It seems that the response I usually hear is, "Think carefully -- for it is horrible to be an artist trapped in a doctor's coat." But I see that you are both a novelist and a doctor. Do you feel that you have made great sacrifices in your writing to be a physician, or vice versa?"

I graduated college in psychology, but am now a technical writer at 24. If I were to become a doctor, I would love to work in psychiatry, neurology or sleep research. If I were to be a writer, I would love to write science-fiction novels. I'm sure it is possible to do both -- but how much time would I have left over to live life itself?

If you have any time, your input, advice or even amusing anecdotes would be tremendously appreciated. I feel that this vacillation is paralyzing my motivation altogether. I am driven toward each career, and yet feel that I must make a choice or forever wallow in compromise as I am doing now."

My Answer:

The most overlooked consideration in giving career advice is the passage of time. People change. So the longer the professional training period, the greater should be your certainty, which is an impossible task given that what sounds great at 24 might seem like a terrible mistake at 50.

Unlike many trades, medicine allows little lateral transfer of skills (although perhaps surgeons can become butchers). Sure, you can switch from research to practice to hospital administration to medical journalism, but the training is much more confining than studying law, journalism or art. Before making any decision, take some time for introspection. Imagine yourself at various ages. Talk to people in different phases of the profession.

More than ever before, being a physician requires a commitment to personal values that may not be adequately rewarded by the general public. Spending more time with your patients won't endear you to your clinic administrator.

But then, slaving over a sentence won't necessarily bring better reviews or book sales. The commercial aspects of medicine and fiction writing are somewhat similar. Unless you are a super-specialist or a blockbuster writer, your income will not compare with that of MBAs or day traders. In both medicine and writing, pursuit of excellence is its own reward.

Regardless of managed care, future care or whatever else is coming down the pike, the thing about medicine that will never disappear is its wonderful sense of drama. Life and death are immune to the vagaries of HMOs. If you really like personal engagement, the nitty-gritty of heartbreak, grief and joy, there is no more rewarding profession. But you must see this as a calling, a commitment stronger than any sense of a life sacrificed or outside opportunity missed. More than ever, going into medicine -- to be a satisfactory choice -- is like choosing to be a man of the cloth.

This is the tricky part about career decisions -- knowing what, for you, is the best balance between internal and external rewards. Much of the dissatisfaction felt by today's physicians stems from their comparing their own salary, praise, status and working conditions with those of business tycoons, software developers and mega-lawyers. Comparison tends to generate envy and bitterness. What you are not privy to at your age is the converse, the underlying sense of insubstantiality that I hear and see among so many of the so-called successful business folk.

Writers have a similar dilemma. The best literature is seldom recognized in today's celebrity- and bottom-line-driven publishing world. Writers can take comfort that they are pursuing their art. But, by the same argument, doctors, even though bombarded by a battery of social forces, can still feel pleasure in their individual patient relationships and accomplishments.

Now for a very politically incorrect comment: Above all, what you need to decide is whether you have a true talent for writing. Without talent, most are best suited for a structured work life, one in which they are not constantly challenged with a blank page or canvas. Routine is God's gift to the unimaginative. Conversely, the artistically gifted tend to be restless, constantly seeking new form and structure in their work.

My writer friends, like myself, might feel envy at the stack of Stephen King or Tom Clancy books in front of Office Depot and K-Mart, but that isn't why we write fiction. The rewards are internal. Even if I were able to figure out a formula for mega-success, I would abandon it for the next book. For me, life is about exploration, not repetition. Which is why I would have made a very poor general practitioner. And why, during this age of brain speculation, neurology has been so much fun.

When I was considering taking up novel writing, I had lunch with a local psychiatrist who was also a novelist. His sage comment: "When I am at a medical meeting, I am glad I am a writer. When I am at a writers' conference, I say, 'Thank God I'm a doctor.'"

Do both and don't look back.