The dilemma I like studying medicine because I want to help people, touch their lives and make a change. I believe that being a doctor gives you lots of opportunities to be a useful member of society. Medicine is at the top of my list of things I find important in life, because it’s going to be my profession. It is a big deal as you affect people’s lives in a big way. But I feel a distance coming between me and medicine, which I don’t understand as I find it so important.

I feel like I can easily mess up. I’m going to start my clinical rotations in the autumn and was wanting to learn some pathophysiology over the summer. I have taught myself lots of things: English, German, French, geometry, biology, and I always enjoyed the journey. But I can’t stay at my desk in order to study medicine. I feel the desire, but… well I’m just not doing it. It feels like I’ll never know everything. I’ll always lack information.

Everything feels too important and I can’t enjoy it when it’s all so serious, when it feels like a life-or-death situation. Is there a way to see medicine as less important, less serious, less risky, less heavy? Something fun/pleasant/enjoyable?

Philippa’s answer It sounds as if you have a Willpower sub-personality who wants to sit at the desk, and you also have your Inner Rebel. Willpower has the words, but Inner Rebel has the action. You seem more familiar with Willpower and need to understand your Inner Rebel better.

At the moment, your Inner Rebel sub-personality is just coming up with excuses, such as, “You’ll never learn it all,” that are not very helpful, or specific. We know what the Inner Rebel doesn’t want – it doesn’t want to sit at the desk, but what does it want? It probably wants a bit of fun, some exercise, maybe some romantic intrigue, some leisure of some sort. Find out what it wants and strike a bargain with it. If you don’t, your body will rebel, which is, I think, already happening to you. This probably means paying as much attention to scheduling fun in your life as you seem to desire to want to spend time learning.

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We make decisions in life based on two main things: how things feel on the inside in contrast to how things look to ourselves and others on the outside. I call it internal and external referencing. Sometimes these two drivers can be at odds with each other. If we are in the position where we can choose what sort of work we are going to do, it is important that we like how we feel when we involve ourselves in the work. That, I think, is more important than merely liking the idea of the work. It’s important that it is satisfying not merely because it looks good to you and others, but because it feels good to you, too. You need to internally reference how you feel more than you need to externally reference how things merely appear – even if they look worthy.

You are looking at the role of doctor, but you are not merely a role. Don’t let the idea of the role, and the meanings you make around that role, obliterate you as a person. You may be playing the role of medical student and later doctor, but you are much more than a role and your patients, and indeed colleagues, don’t just want someone playing a part – they need a real person to relate to. And when you can relate to your colleagues and patients and embody your learning, which you will do when you have more practical experience, then it will all make more sense and be more enjoyable.

Being human means not knowing everything. You will never know everything, even after you have been a consultant for 20 years. You are not supposed to know everything, you will always have to discuss cases with colleagues or look things up or do research – and you will learn to tolerate that not everything is knowable. If you thought you did know everything, that’s when practising medicine would become more dangerous.

Soon you will be getting out on the wards and listening to how people experience their bodies, probably an easier, more interesting way to become familiar with pathophysiology than just reading it, and when you get to the psychiatric wards you will hear how people experience their minds. You will be better at this if you can learn how to listen to your own. And you have the perfect dilemma to start on: your split between wanting to study and not doing it.

Be curious about what the Willpower sub-personality part of you wants and why, and what that Inner Rebel part of you wants as well. See if you can work out a compromise between these two parts of you. Be curious about whether your desire to work in medicine is internally or externally referenced. If you only want to do it from a desire to be useful and not because you have a curiosity about medicine for its own sake, then it is not too late to change direction.

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