“When she transformed into a butterfly, the caterpillllars spoke not of her beauty, but of her weirdness. They wanted her to change back into what she always had beeeen. But she had wings.” - Dean Jackson

Even I can recognize that (at least outwardly) I have indeed molted from an earth-bound caterpillar into a monarch with beautifully colorful and powerful wings over the past few years.
My wings are the pages of Physician Outlook Magazine.  
It is no secret that physicians are an endangered species.
The physician-patient relationship is on the brink of extinction.  

Those of us who aspire to become physicians spend the first three to four decades of our lives in a pre-larval, sheltered existence. When we first hatch, our first meal is the fragile thin exoskeleton provided by our parents and the village that raised us.  
We then voraciously feed on the leaves of the Asclepias syriaca on which we are carefully laid. For those of us destined to become Doctors of Medicine or Osteopathy our “milkweed” consists of medical school, residency and the fellowship programs that prepare us to take care of patients. Like the tiny caterpillar that hatches from the egg, our knowledge increases its body mass thousands of times before we are finally ready to venture out into the world and actually “practice” Medicine.

We know that only a fraction of us will survive into “adulthood” but yet we persevere. We do what we do because it is part of nature’s cycle. Not all of us will get the opportunity to use our wings to complete the transcontinental journey, but we nevertheless spread our wings in flight. We purposely and deliberately cross-pollinate the flowers in our gardens. We know that we play a vital role in our globe and in humanity’s survival.

By the time we realize that forces greater than ourselves are plummeting us toward potential extinction, many of us find ourselves flapping our wings without purpose. The monarch butterfly faces landscape-scale threats from global climate change, poorly planned urbanization and development, and pesticides. The threats we physicians and patients are challenged with are much more insidious--they come in the form of thinly veiled special interests that pretend to control healthcare costs and make our jobs ‘safer’ by inserting themselves as intermediaries.  

Many of us in medicine are still in our pupal stage, our most vulnerable time in terms of survival, but also our most promising. We know that only a fraction of us will survive the chrysalis stage, as being a caterpillar is the most dangerous in our life cycle. In nature, the dangers are predators and parasites, disease, and unfavorable weather conditions. In medicine, the threats are surprisingly similar. The predators and parasites in OUR world, however, are camouflaged in fancy suits, dictating how we care for patients with their never ending bureaucratic rules and algorithms.

I spent many years of my career in the pupal stage, spinning silk to form my protective exoskeleton, sometimes curling up into a ball to protect myself from the elements. I shed my skin one last time when I founded Physician Outlook. My wings are dry and powerful.
I am ready to take flight and make the long journey with the other monarchs who are truly committed to preserving our profession.
It was an inspirational physician coach who helped me to recapture my joy in medicine.


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