(The alternative title for this article was “If They Don’t Play Prog Rock at My Funeral, I’m Not Going!”. The editorial team felt this was worth a mention.)
My son Josh and I were texting; he was at home in Honolulu, and I was at mine in Asheville. We were 5,000 miles and six time zones apart, yet we were completely one in musical taste. He sent me an early version of Peter Gabriel’s “Here Comes the Flood,” recorded on Robert Fripp’s solo album Exposure. It’s the best because it’s just Peter singing, playing piano, and accompanied by Robert’s guitar.
Josh, a writer by profession, texted, “The lyrics may have been one of my first authentic encounters with the poetic.” He singled out the line, “It’ll be those who gave their islands to survive…” My thoughts immediately went back to Fripp and King Crimson four years earlier, specifically the LP Islands and its title song. I sent it to him, isolating the lyric: “Islands join hands ‘neath heaven’s sea,” written by King Crimson lyricist Peter Sinfield.
“A truly underrated album,” I texted him.
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Indeed, many people who commented on the YouTube channel shared the same view. “This is the reason why the ability to hear was created,” one person remarked. Another quipped, “I’m not friends with anyone that doesn’t like this song. They aren’t welcome to my island.” And not unexpectedly, someone wrote, “This may be the most beautiful song ever composed.”
But the best summation came from someone who said, “If they don’t play this song at my funeral, then I’m not going.”
Josh and I chuckled at that line. After all, I introduced him to prog rock when he was growing up, and he still loves music from that era. Most of all, the individual’s statement is true. When my time comes, I wouldn’t hesitate to include “Islands” on my celebration-of-life playlist.
What other prog rock songs would I include? That’s a bit trickier. I imagine many people at my funeral won’t be familiar with music from the mid- to late-1960s through most of the 1970s. Exposing your audience to a song they’ve never heard before can be an ordeal. Besides, what was most meaningful to me may have little, if any, impact on them.
This is true not only of music but also of my career in medicine. I have been immersed in the medical field for five decades—first in practice, then in various nonclinical roles. Medicine is essentially all I know and what I want to talk about, except for outdated music and, of course, pride in my family. I know what you are thinking: BORING.
You may be correct, but it’s important to distinguish between what I want to engage in voluntarily and what I’m capable of. I’m well-versed in life. I can hold a conversation with just about anyone on virtually any topic, even artificial intelligence. But is that my choice? Hardly. We might connect over music, family, or current events. Fine. But I find myself gravitating toward medicine, and if the party isn’t interested, I brush them off like lint.
I have noticed this dynamic for years: the tendency to talk only about medicine, to the exclusion of other topics. I don’t believe doctors necessarily want to talk primarily about medicine, but institutional pressures, training, and cognitive fatigue no doubt compel them to. In fact, in social settings, I believe many physicians actively crave nonmedical conversations to escape the intense demands of their jobs.
However, in clinical settings, studies show a distinct disconnect—nearly half of surveyed patients report that their doctors rarely talk beyond immediate physical medical needs. Perhaps they don’t have enough time for small talk. Perhaps they don’t think social determinants of health matter. Certain topics, for example, politics, are considered verboten.
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“Medicine is my native tongue. It was the language I spoke for years.”
Because I no longer practice, these explanations don’t apply to me. Why, then, do I tend to talk only about medicine, even though I’m capable of other conversations? Am I the only one who leans this way? I don’t think so.
I believe what I am experiencing is a deeply ingrained psychological and cultural phenomenon that is common among older, retired, and nonclinical physicians. When a doctor spends decades in the intense socialization of medical school, residency, and practice, medicine stops being just a job—it becomes a core identity and cognitive framework. Leaving active practice removed institutional pressures, but it did not instantly rewrite how my brain was wired to process the world and connect with others.
While researching this topic, I found several psychological reasons why physicians might still default to medicine to the exclusion of other topics:
- Conversational “Fluency” and the Drift of Common Ground. Medicine is my native tongue. It was the language I spoke for years. Shifting to other topics feels like trying to converse in a second language, where the vocabulary doesn’t feel as rich or satisfying. It takes time and conscious effort to relearn how to speak other “languages” socially.
- Semantic Gravitation and the Atrophy of Nonmedical Vernacular. The casual, non-analytical language of hobbies, pop culture, or small talk simply hasn’t been used as much, so my brain defaults to its strongest muscle: medicine. The gravitational pull of medical terminology and concepts requires the least friction to express complex thoughts.
- The Comfort of an “Expert” Identity. In social settings, defaulting to medical topics can be an unconscious way to maintain my sense of mastery, competence, and relevance.
- Cognitive Conditioning and Problem-Solving. When chatting with others, I might unconsciously look for “problems to solve” or “cases to analyze” because my brain still craves the dopamine rush of clinical problem-solving, even in purely social settings.
- Shared Trauma and the “In-Group” Bond. Talking about medicine—even the dark humor and absurdities I’ve written about—feels deeply authentic and helps me connect. Shifting to broader topics like world news often feels superficial or unstimulating by comparison.
- Delayed Processing of a Life in Medicine. My tendency to keep bringing up medicine is probably my mind’s way of slowly digesting and making sense of a lifetime of intense experiences.
Knowing all this can help me and other “entrenched” physicians explore ways to expand my conversational repertoire. Yet when I talk off-label, you’ll most likely be schooled in rock ‘n’ roll and its contributions to baby boomers’ identity. And if they don’t play at least one prog rock song at my funeral, I won’t attend.
