This week, Ryan and I brainstormed about our family “mission statement.” I find that it’s helpful to be very clear on what my values and goals are and to re-visit them frequently, to help me stay focused on what’s truly important. This helps me avoid getting sidetracked by things that seem valuable on the surface, but don’t actually help me stay aligned with my core values and goals.

Sharing love and light with the world is at the core of how we want to live our lives, and career, or livelihood, is one key area in which we want to manifest this mission. What does this mean for me as a geriatrician? In an obvious sense, it’s very important to me to interact lovingly and compassionately not only with my patients and their families, but also with the myriad members of the geriatrics care team–it takes a village: nurses, nurse-practitioners, doctors, certified nursing assistants, family caregivers, clerical and support staff, social workers, pharmacists, physical and occupational therapists, dieticians, chaplains, recreational therapists, podiatrists, janitors, medical subspecialists, administrators and more.

But in a bigger picture sense, I think about the meaning of the Dhamma concept of “right livelihood.” Right livelihood is the fifth fold of the eight-fold path taught by the Buddha. I struggle sometimes to reconcile the numerous problems in American healthcare with right livelihood. Is contributing as a clinician to a dysfunctional system with misguided paradigms right livelihood? Or should I be throwing all of my energies into changing the system and its underlying assumptions? Trying to take on both is challenging.

A Google search turned up the following:

Vipassana teacher S.N. Goenka said, “If the intention is to play a useful role in society in order to support oneself and to help others, then the work one does is right livelihood.”  [O’Brien, Barbara. “Right Livelihood: The Ethics of Earning a Living.” ThoughtCo, Sep. 1, 2017, thoughtco.com/right-livelihood-the-ethics-of-earning-a-living-450071.]

Considered from the perspective of intention, both paths are in line with right livelihood, and staying focused on clinical practice is an absolutely acceptable option–clinicians are needed, even in the broken system. However, as a clinician, it is not acceptable for me to be a complicit cog in this economically driven medical system.  I have a duty to find ways to be the kind of clinician I want to be, to practice medicine I believe in. There are formidable barriers and constraints to doing this, but that is the useful role I can play in society.

“Work diligently. Diligently. Work patiently and persistently. Patiently and persistently. And you are bound to be successful. Bound to be successful.” –Goenkaji