The Heart of Medicine: Introducing Ikigai

Daniel Kalish, DC

Ikigai is a Japanese concept that translates to “reason for being.” Ikigai posits that one of our primary life goals is to enter into the deeper levels of contemplation to uncover what our purpose is—our life purpose. Understanding why we are here is a means to understanding how to plan a career and a professional life.

My longstanding spiritual teacher, Jon Bernie, once told me his life took on a whole new meaning when his personal life, professional life, and spiritual life all merged and became one. It’s so easy to fragment and separate ourselves, dividing our time and sacrificing our inner self in order to pursue professional goals. Ikigai “just says no” to this type of thinking.

A simple diagram can be used to help you determine your Ikigai. It looks at four key questions, so we can apply this type of soul searching activity to our business planning. Why consider this idea? Because most of the time, Functional Medicine practitioners develop their career around others, and this puts them at a high risk for burnout.

This can manifest in two ways. First, I often see practitioners emulate senior Functional Medicine doctors and teachers, striving to create a similar practice to that of the teacher without considering if it’s a good fit. Second, I see people build practices based primarily on patients who randomly present themselves. In other words, a practitioner helps one autoimmune case and then suddenly has hundreds of these patients in their practice. We, as healers, believe we need to help everyone with everything, and we don’t try to understand, let alone accept, our own limitations. We often don’t include our own preferences in the ways we structure and build our businesses.

Therefore, we frequently see Functional Medicine practitioners wake up one day in a practice that isn’t exactly what they want. This leads to physician burnout.

It’s easy to confuse self-centered thinking with understanding your purpose. If your purpose is to help autistic children, then of course you must push in that direction as fully and quickly as possible to help the maximum number of kids you can. If, however, you are good at that type of work, but are not passionate about it, then you need to rethink what patient population you would be better off serving.

This is where the planning part comes in. You are much more likely to maintain a practice for decades if you find your sense of purpose first, and then base your business planning around that, rather than “falling” into something that is a poor fit and getting stuck doing that when it is less than ideal. For example, my main teacher worked with cancer patients. I found that level of practice to be overwhelming, and I didn’t feel like I could personally deliver what those patients needed. It took me over three years to figure out that I was doing the cancer patients as well as myself a disservice in my attempt to work in an area I wasn’t passionate about.

So back to Ikigai. Grab a notebook and pen and write out the answers to these 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?

For me, it always comes back to two things I’m passionate about: running a bicycle shop and leading bicycle tours or treating Functional Medicine patients. For now, I’m sticking with Functional Medicine. However, in my practice, I maintain the following rules: I don’t treat those with life-threatening diseases (e.g., cancer) and those with two chronic conditions that I’ve found I’m not well suited for: Lyme disease and mold exposure. I have excellent doctors in my area who I consistently refer to for any cancer, Lyme, or mold patients, and I know that the patient will get far better treatment working with those folks than with me.

I’m not talking about refusing to treat patients, and I’m not talking about turning people away. What I am talking about is finding the best fit for yourself, and finding the best fit for every patient who comes your way, with the realization that you don’t have to help every patient yourself. You do have an obligation to know to whom to refer for the conditions you don’t work with. Recently, I had a 23-year-old female patient with bipolar disorder, and I was able to refer her to just the right psychiatrist for her specific case. Last week, I found out she is symptom-free now, and that working with my referral doctor is the best thing, literally the best thing, that’s ever happened in her life. To me, that’s a patient I served well by my expertise, albeit it was a well done referral that made it work. Basketball fans will understand this analogy: it’s like watching my home town team the Warriors play, when often times the best player makes the best pass, but a different guy makes the basket. But you know, okay, that pass was just incredible.

So, once again, consider the Ikigai contemplation:

  1. What are you good at? Only work in an area of Functional Medicine that you can excel at; don’t choose something that you are mediocre at or can just get by with. Imagine you want to go to the Olympics and will spend years training hard—you are going to want to pick an area you know you can lead the world in, not just something you are decent at.
  2. What can you get paid for? If you are really good at crocheting sweaters, but there’s not much of a handmade sweater market in your community, then you should think about something else. Pick an area to pursue that patients see real value in and will pay for.
  3. What does the world need right now? It’s pretty obvious that most of the American population is now overweight or obese and at high risk for diabetes and cardiovascular disease. The world needs help in that area, right now. It’s clear that many couples can’t conceive, so fertility as an area to specialize in makes sense. If you are an amazing golf pro and golf coach, but you live in northern Alaska where there are no golf courses, you need to consider finding another area of expertise.
  4. What do you love? Okay, this is where it gets hard. You need to find something you are good at, something that has value to others so you can make money, and in an area where the world needs your services. But that’s not enough. It has to be something you love, not something you pick because it makes sense or the demographics in your area work or because someone else is doing it.

If you feel even a little burned out or unsure about your current professional trajectory, or if you are not thriving in your professional current job, consider working through your own Ikigai. After over 10 years of refining my own Ikigai, I can honestly say that at the end of a full day of patients, I have more energy, more loving kindness, and more zest for life as a result of working with people than I did when I started the day. This is a formula for a long and successful career, and it will make you 100% “practitioner-burnout proof.”


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