The toughest choices I’ve had to make in my medical career

By Courtney Manser, MD, CCFP (PC)
Published May 9, 2023

Key Takeaways

There are a lot of tough choices in medicine—from personal choices, such as what specialty to choose, to medical choices, such as how to best treat a patient. It’s long been known that critical thinking and ethics are integral parts of the practice of medicine. However, the hardest decisions I have ever had to make in my medical career were not about others, but about myself and my own well-being. 

The difficulty of balancing work life with home life

Medicine is all-encompassing. Most of us went into medicine because we wanted to help people. Those words are written on medical school applications around the world—and most of us truly mean it. The trouble is, people don’t stop needing help at five o’clock. They don’t wait until Monday morning to develop appendicitis or a bowel obstruction. It’s not easy, or even realistic, to believe you can shut your brain off and not take work home with you. 

As a palliative physician, medicine always demands more of my time. People are always dying. It’s always a sad case. In fact, when it comes to people’s health, it’s always important. But what about the physician’s health? At various points in my 12-year career, and most prominently just last year, I found myself asking, “What about me?”

Pervasive feelings of guilt, no matter what

As a mom of two, there is always guilt—guilt if you do, guilt if you don’t. My patients needed me, so I worked more. But then I felt guilty about the time it took away from my family. 

"When I took time off from work, I felt guilty about not supporting my patients. But what about what I wanted? "

Dr. Courtney Manser MD, CCFP (PC)

Spending time with family has always been a source of joy, but I didn’t know how to do it without feelings of guilt. So, I pushed on. The pandemic hit and more patients than ever were seeking home palliative care—so my partner and I took them on, because we wanted to help people. And it was a sad case. Every case was a sad case. So, I worked longer hours. I answered my phone after hours and on weekends. And because I had more patients, I spent less time with each of them. So, they demanded more. So, I worked more. 

I thought that I was juggling home and work just fine. I’d wake at the crack of dawn to prepare lunch bags and head out on the road while it was still dark to allow myself family time in the evening. But I was on edge all the time. I was becoming forgetful and I wasn’t sleeping well. I stopped humanizing my experience with patients. In fact, I found it hard to care at all. In retrospect, I was suffering from burnout a year before I finally made a change.

But then I broke. It wasn’t one thing in particular that caused me to break, it was twenty.

That break caused me to make the toughest decision I have ever had to make in my medical career: I chose me, and I quit my job. 

The guilt and shame involved with that was immense. I can’t cut it. Other physicians can manage; why can’t I? What is wrong with me? I didn’t even know if I was going to continue to practice medicine. 

I took some time off. I got back into writing, and I spent much needed time with my family. 

"To say I didn’t continue to carry the guilt and shame of my decision for months would be a lie, but those emotions did improve with time. "

Dr. Courtney Manser MD, CCFP (PC)

Coming back to medicine

Since then, I have taken up home palliative care again, though to a much lesser extent. Seeing fewer patients has allowed me to spend more time with them, to focus on them, to get to know them. I think it humanizes the experience. And in fact, I feel like I’m a better physician because of it. 

Over the years, I had experienced these feelings to lesser extents. I made small changes to my career or I took a vacation and I was able to get back on track. But every time, choosing me was more difficult than any patient decision. And this time, the dire need to choose myself was undeniable.

I can say now that I am a recovering burnt-out physician. And the only reason I am in recovery is because I made the toughest decision that I have ever had to make in my medical career—I put myself first. 

Now, I am more self-aware. I take time to exercise, I get to sleep at a decent hour and try to be more present in my day-to-day life. There’s a reason that airlines tell you to always put the mask on yourself first before helping others: If you’re not healthy, who will be there to care for the patients?

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