A two-edged sword: Narrative inquiry into Japanese doctors’ intrinsic motivation

Introduction: Although retaining a healthy and motivated medical workforce is becoming an intractable problem, the intrinsic motivation that keeps doctors working for patients remains under-investigated. The 2011 Tohoku earthquake and tsunami provided a unique opportunity for culturally situated research into doctors’ intrinsic motivation. The purpose of this study was to answer the research question: what motivates doctors to work for patients above and beyond expectations? Methods: This paper reports a qualitative inquiry informed by semi-structured individual interviews with 15 Japanese doctors who had joined disaster relief activities, which uses the Bushido virtue code as a conceptual framework. The authors read transcripts repeatedly and conducted a cross-case analysis to identify final themes and illustrative narratives. Results: A young doctor wanted to learn by testing out his capabilities. A senior doctor yearned to be of value to others. Other participants told how identifying with victims motivated them. There were negative as well as positive motivations, exemplified by a participant whose sense that well-educated people had a duty to help was coupled with a wish to avoid being blamed by others. Discussion: Volunteering met participants’ needs for self-esteem by restoring their relationships with patients to ones in which they had some measure of control. But avoiding being blamed or losing Meiyo (Honour) also motivated physicians to volunteer. Reinforcing the satisfaction of a job well done may help offset the lack of control, guilt, and shame that too easily results from the relentless pressures of workload and external accountability in today’s healthcare systems.