Doctors are often put into positions that can cause them stress, burnout and depression. Many doctors will reach a stage in their career when they question their choice to practice medicine. If this sounds like you then perhaps the concept of Ikigai is worth reflecting upon. Ikigai is a Japanese word that roughly translates to “reason for being.” It is similar to the French term raison d’etre.
If you are able to combine Ikigai and Medicine. It could be the reason why you get out of bed in the morning. Ikigai can be found through any activity that brings joy, which is why it’s important to find these activities and indulge in them more often. The problem is there are powerful barriers in Medicine that can prevent us from finding our Ikigai. Most notably salary expectations and the stigma of being seen to “reject” a career in medicine for something else.
The Japanese Concept of Ikigai
Ikigai is closely tied to the Japanese concept of Seika (貞知). Seika is about making the most of your life. Every human being has the opportunity to lead a fulfilled and happy life. The concept of Ikigai, which was formed by Japanese author Haruki Murakami. Ikigai does not require that an individual’s pursuit of happiness be grandiose or complicated, nor does living a fulfilling life mean achieving success as defined by society; one might find meaning in their work as an engineer for example.
Everybody has a reason for living. For many of us, pursuing our goals and passions is sufficient motivation to meet life’s challenges. But some people have trouble identifying what is important to them. Sometimes it takes a tragedy or a crisis to help with this realization, but most often, it just happens naturally as we grow older.
Moral Injury and Medicine
Working in the medical profession, we can often encounter a stage where we question our worth or whether it is worth it. We may feel guilty or ashamed of what we are doing in our work. It is a very common feeling and one that can be extremely debilitating. One reason we may question our worth as medical professionals is through moral transgressions.
Most of us are taught early on that the right thing to do is the moral thing to do. It means that you are doing what is right. If you are forced into a position of not doing exactly the right thing. You might think that it is not very important, but it still matters because if you do things differently, then you are doing something wrong by being bad. If you are constantly put in a position where you feel you are not doing right, it will eventually challenge your resilience and cause moral injury.
Moral injury is a concept in psychology and psychiatry. It is thought to arise from feelings of guilt or shame felt by an individual who has taken part in wrongdoing, for example, war crimes, genocide, torture, or other such atrocities. Whilst these are extreme examples of wrongdoing we can also experience moral injury if we are constantly put in a position in our work of feeling that we are not doing good or constantly having to compromise on what is right.
A classic example in medicine might be the feeling that we are constantly medicalising people’s problems, i.e. providing medications or physical treatments when the root causes are far deeper than this. Or being forced to discharge patients when the care available at home is inadequate because we need to create beds for “sicker patients”.
Finding Your Ikigai in Medicine
As I have noted, Ikigai is often translated as ‘reason for being, the reason why you get up in the morning. It is believed that your Ikigai must be fulfilled before you can die. While it is not always easy to find one’s Ikigai, there are some things to remember when searching for it.
How to find your Ikigai
Many people search for a sense of meaning or Ikigai in their life. You may find your Ikigai by doing what you love and pursuing your passions. Ikigai is found through actions and not just through words. It can be found in medicine, as well as other professions. For those of us looking for our Ikigai, we can find it most easily by taking action and finding the things that speak to us and energize us.
It is important to understand that Ikigai is not just about your own personal purpose and fulfilment. It is also about your contribution to society at large. In the end, Ikigai should bring meaning and purpose to your life while you contribute to the good of others.
It is said that everyone has an Ikigai – their particular intersection of passion, talent, and potential to benefit others. It is only a matter of finding it. The journey to Ikigai, however, might require significant time, reflection, and effort to get there.
From a personal perspective. As someone who has always felt a little edgy about their career and a desire to try new things. I wonder if Ikigai is perhaps more of an iterative process for some.
But How Does Ikigai Pay the Bills?
Ikigai is not just about finding meaning and purpose. It can also be about making money.
Ikigai can be a way to work out how to make a living whilst feeling fulfilled and with purpose. Ikigai does not have to be part of your formal career. It can be part of your hobbies, your family or a profession. Ikigai is not necessarily tied to a job, but it is tied to a passion. It is about finding the job that is the right fit for your passion.
In order to arrive at our Ikigai, we can consider four key spheres. (Note: this concept relates to the author Hector Garcia’s conceptualisation of Ikigai, not the original Japanese concept)
I Love It!
Clearly, this sphere encompasses what we do or experience that brings us the most joy in life and makes us feel most alive and fulfilled. This might be playing cricket, singing in a bad, playing computer games, hanging out with friends or travelling the world.
What is important here is to think about what we truly love without thinking about whether we are good at it or not and whether we can earn a living from it. This is the most indulgent sphere.
Something I Am Great At
This sphere includes anything you are particularly good at. These can be skills you have learnt or hobbies you have pursued, or talents you have had from an early age. What you are good at might be, for example, playing the guitar, displaying empathy, sports, performing surgery, or painting pictures.
This sphere encompasses talents or capabilities, whether or not you are passionate about them, whether the world needs them, or if you can get paid for them.
The World Needs This
Whether it’s the entire world or a small community you are in touch with. The “world’s” needs might include skilled doctors, clean energy, volunteers, or improved teacher training.
This is the area of Ikigai that is most practical. It connects most explicitly with other people and doing good for them beyond your own needs.
Can I Get Paid For This?
This dimension of the Ikigai diagram also refers to the world or society at large. It involves a transaction where someone else is willing to pay you for something you provide. Or that there is a market for your skills or expertise. You might be passionate about your poetry writing or be very good at canoeing, but this does not necessarily mean that you can get paid for it.
Whether you can get paid for your passions or talents depends on factors such as the state of the economy and whether your passions or talents are in demand.
Ikigai and Medicine – Threading the Needle?
What I notice most about the Ikigai concept is how much overlap one needs between these 4 spheres of love, good at, need, and monetizable.
I suspect it is for this reason that many of us settle on compromises where we end up doing things that the world needs (and there are plenty of medical jobs that fit this bill) or things we are good at. So we can get paid for our efforts. But missing any passion or sense of mission for what we are doing.
Barriers to Ikigai in Medicine
You only have to work your way through this recent post to see that money is probably one of the biggest barriers to doctors gaining a sense of purpose and Ikigai.
If we are lucky, we do find an area of medicine we truly love. That has a need and needs us and our skills. But it may well mean that we compromise on our salary expectations somewhat. I say somewhat because a salary compromise in a medical career still represents an outstanding salary in most other people’s careers.
So, for example, even though we are quite good at surgery. We might choose to work in general practice as we have more autonomy over our patient care decisions and get to work holistically with people which we love. In so doing, we probably compromise somewhat on salary expectations. But we probably also create room for other things we love in life, like family and hobbies.
However, as doctors, we have the potential to create economic expectations for ourselves that can trap us in careers that are creating us harm. Doctors generally have good credit risks. So we often end up servicing high loads of debts and other financial expectations, which can make exciting a particular medical career difficult.
Finding Your Ikigai Alongside Medicine
Perhaps your medical job is not your be-all and end-all. Perhaps it’s your way of paying for the thing in life that brings you passion and satisfaction and others enjoyment?
I certainly know of many doctors who work so that they can indulge their passion in music or the arts and, in so doing, bring joy and something to others that they need.
Consider also those doctors who do stints working for organisations like Doctors Without Borders. The years of critical care training and experience at home may not be exactly what they would like to be doing on a daily basis. But the trips abroad where they can “make a real difference” helped to balance out having to fight the bureaucracy of hospital care in your real job whilst you are maintaining and improving upon your skills.
Finding Your Ikigai Out of Medicine
And finally. Maybe it’s just possible that the skills, talents and passions that brought you into Medicine are the sorts of skills, talents and passions that are needed in other parts of our world.
Maybe. Just maybe. It’s possible for you to find a career completely outside of medicine.
Here is where I think doctors face another real but under-recognised barrier to finding their Ikigai. Which is the stigma and possible shame or guilt associated with being a doctor who is no longer a doctor.
I was once providing career coaching for a doctor who was considering exiting medicine altogether for a career in real estate.
Real Estate happened to be something that she loved and was very good at. Having flipped several properties on the side during her medical school and training. And, of course. The world needs houses.
What surprised me most of all about our encounter was her statement that I was the first doctor that she had ever talked to who would even consider not working in medicine as a possible career choice.