“Closer to Falling Than Jumping:” The Winding Path to a Specialty

Matthew MacKinnon '15
uvmmedicine blogger Matthew MacKinnon ’15

How to choose a specialty: It’s arguably one of the most difficult questions facing many medical students across the country. As I started to reflect on my own experience choosing psychiatry as a career, I realized that my narrative tells only part of the story. In the hopes of easing some anxiety surrounding the art and science of choosing a medical specialty, I wanted to address the more universal process. The following are some of my observations:

A common idiom claims that hindsight is 20/20, but I would suggest it is 20/200 at best.  Why do I think that hindsight is legally blind?  Because the process of rationalization incurably distorts retrospection.  We will flesh out this concept after I introduce my central postulate:

There is no right specialty.

The human brain evolved to categorize, label, and thus, gain a sense of artificial control over its environment.  The brain needed to be able to file the red berry of a certain shape under the poisonous category and the blue berry of a different shape under the edible category.  We created storage bins in our minds and neatly filed our world into them.  When we arrived at an uncategorizable grey area, our filing system fell apart and we chose the wrong berry.  Thus, evolution rewarded black and white thinking because it is an effective survival strategy, not because it is a successful way of perceiving the world.

In modern times, red and green traffic lights instill no sense of emotional turmoil, while the yellow light causes endless consternation; we brake or speed up, all the while worrying away at the uncategorizable traffic signal.

We want to believe there is a right specialty.  We are programmed to think that there is an irrefutable answer to the question of which specialty to choose.  But this desire for an infallible answer clashes with the reality of a world defined by yellow lights.

I would suggest that “right” is determined by retrospective rationalization and nothing more.  We make our present feel more secure by rationalizing that our past was “right” or “wrong.”  In actuality the events in our life simply are; they do not arise with any agenda and know no emotional connotations.  They stand resolute against all of our rationalizations, comfortable in their unassailable existence.

Humans are unbelievably adaptive organisms.  The notion that your happiness can only be found in a single specialty is akin to believing that only one geographic location can provide contentment.  Sure, some of us have a latitudinal or longitudinal constraint to our inhabitance, but there are vast areas within these constraints that will provide what we desire.

But what to do about the incessant question: What are you going in to?  After all, this is the medical school version of “Where are you from?”  Unless you have previous experience in a certain field of medicine, your knowledge of the actual day-to-day of a given specialty is relegated to pure imagination during your first two years.  As you enter the hospital during your third year, this imaginary construction begins to take on a reality-based form.  And hopefully by your fourth year you have filled in this conceptualization enough to have a moderately accurate perception; that being said, there is no need to await clarity to answer the specialty question.

Don’t be scared to be hypocritical, entirely convinced of one specialty one day only to be entirely convinced of another the following day.  The process of answering is more important than the answer itself.  Your mind is able to cast itself in the role of a surgeon, radiologist, or family practitioner when you verbalize your answer.  You will begin having brief glimpses of your perceived future and develop a taste for the specialty as the words exit your lips.

As you progress further in your education, this taste will become more robust and textured with the addition of new information.  Eventually, when you answer the specialty question you will have some actual substance to chew on.

I hope this article has provided some relief from the phantom ticking of the specialty clock.  Picking a specialty is closer to falling than to jumping.

For those interested, the articles on my site, MindfulnessMD.com, describe more about my connection with the field of psychiatry and my path to this specialty.

What are your thoughts about this topic?