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Making Peace with Purpose

Dr. Kara Pepper joins the blog today to talk to us about physician wellness and purpose. Through her own story of physician burnout, she has been able to learn and grow. She now shares her knowledge as a physician wellness coach in her journey to care for and support fellow physicians in finding and maintaining purpose.

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Tell me, what is it you plan to do with your one wild and precious life?

Mary Oliver, The Summer Day

Ikigai is a Japanese concept that means "a reason for being". The word "ikigai" is usually used to indicate the source of value in one's life or the things that make one's life worthwhile. The word translated to English roughly means "thing that you live for" or "the reason for which you wake up in the morning." Each individual's ikigai is personal to them and specific to their lives, values and beliefs.

Ikigai can be explored by answering four questions:

  1. What am I good at?

  2. What can I be paid for?

  3. What does the world need right now?

  4. What do I love?

I internalized at an early stage in my medical education that medicine would be my everything: my life’s calling, my purpose, my contribution to the world, my joy and privilege. Through explicit and implicit messaging, I internalized that in return for my hard work and sacrifice, I would gain entry to an honorable profession that would be my Ikigai.

Throughout my training and practice, I identified myself at various places in this diagram. In medical school, I provided medical care for free, finding myself delighted without wealth. The first day of intern year, I had a Mission, but I was not competent in my Profession. When I went through epic burnout seven years into my career, I believed that I was simply getting paid for a job that I hated and I was making no difference in this world - medicine was a Vocation without Passion. These days, I float near the center of this diagram, but rarely fixed on Ikigai.

When you look at this diagram, where do you find yourself? What I have come to appreciate, and what I would like to offer you, is that wherever you are, it is neither right nor wrong. It is just information that can help guide decisions and direction.

When I think of my answers to the four questions above, I know that I am a great primary care physician who makes a good living providing services that our country needs. Thirteen years into practice, I still love taking care of patients. So is medicine my ikigai? I can’t give a definitive yes.

What is not captured in this diagram, is the personal cost of medicine as my Ikigai. For me to practice medicine effectively, allowing time for sleep and self-care, personal connections, and the mental and emotional recovery from the work day, there is little room for anything outside of medicine. Medicine swallows me whole and seeps into every aspect of my life. It is no longer “the thing I live for.” It feels too small, too restrictive, too out of touch with who I am now and who I am becoming.

The concept of ikigai, as well as this diagram, doesn’t ask, “What do you need now? What’s next? Who will you become?”

I can no longer expect my practice of medicine to consistently match the idealism of Ikigai. In the process of my burnout recovery, I made peace with my purpose. I recognize the gift it is to practice medicine, but I must allow space to imagine what comes next. I am not the 23 year old whose biggest dream was that medicine would be everything to her. Now, twenty years later, I realize that there is so much more to who I am and what I want in my life. Medicine was my ikigai, and now I find myself asking, “What next? What else? Who else?” I have outgrown my ikigai.

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