Post
Why Medicine Again?
Medicine isn’t what it used to be. I’ve talked to alot of physicians, researchers and residents recently and I’m not encouraged by what I’ve heard. What seems to motivate many students now isn’t a passion for helping people, it isn’t an unfailing dedication to the art of medicine, it’s comparably trivial things like money, recognition and lifestyle.
“Lifestyle“, that’s a word I hear often and it’s nothing but wrapping a nice word around hollow motives. The most competitive residency programs are in dermatology and plastic surgery. Why? Well, apparently that’s how you work the least and make the most money.
An anesthesiologist I met on a flight recently boasted about the ease of his profession. He’s active only a few hours a day and for most of those he’s kicking back after administering a few drugs. He cited the limited communication with his patients as an apparent “perk” of his specialty.
Physicians today are also prone to the influence of pharmaceutical companies, prescribing drugs like tic tacs. I’ve been shadowing a rheumatologist for several years and it’s not uncommon for patients to come in with bags full of prescriptions, each one of their doctors having added a few medications (some to counteract side effects of others). While recent legislation has limited the gifts that doctors can accept in several states, there are no such restrictions on hosted conferences (sponsored vacations). So, there is still considerable interest in maintaining the current system.
By no means are all doctors this dishonorable, but the existence of just a few tarnishes the reputations and hinders the efforts of real physicians. The doctor-patient relationship is sacred and requires complete trust for the doctor to learn what he or she needs to make an effective diagnosis, and for the patient to actually follow through on the doctor’s plan. If doctors are only in it for the money, how can a patient trust that their diagnoses are well-researched? If doctors are in any way influenced by pharmaceutical companies, how can patients be sure that they actually need the drugs they’re given?
When (not if) I take the Hippocratic Oath, I will actually heed its very simple points. A doctor is responsible for the health and life of his or her patients, a task that permits no gray area. Any sacrifice of the patient’s health or violation of their trust for convenience or profit is plain wrong.
Do I just feel like this because I’m still a naive student, will I change in medical school or later? I don’t think so, I’ve assessed and reassessed my motivations and they’re real. In fact, it was this motivation that inspired (possessed?) me to work so hard for my MCAT’s and for the tests that are sure to keep coming. I couldn’t have gotten through those last weeks and today’s exam if my reward was money. Whatever specialty I choose, I will serve people honestly, passionately and with respect, I will never let profits or any company affect my judgement, and I will “enter only for the good of my patients”.
Below are the reasons that I want to be doctor, my personal statement:
My path towards medicine began early (after all, I had picked up the toy stethoscope not the fire truck) but veered widely as I developed in my academic career. My background in philosophy first triggered deeper questions into my motivation for medicine as I struggled with impossible questions about life, purpose and truth. After a Cartesian dissection of my beliefs (one that left his cogito etched in me), I found that there were few things I could hold firmly, but those that I did would withstand any assault.
Namely, I discovered that I cannot wait for a role to be dealt to me, and therefore I know only that I want to be positive weight in the balance of the world. When I last travelled overseas, I saw many people suffering from illnesses whose treatments were either unavailable or far too dangerous given the conditions. The same thing is happening around the world on an unimaginable scale. In the face of so much suffering (easily the heaviest counterweight in that balance), I’m immediately struck by a sense of purpose and a desire to help. When millions die every year from preventable/curable diseases, it is clear that we have lost our basic respect for personhood and obligations to one another as human beings. I want to be a doctor because there is no worthier means of defending this fundamental right to life.
My experiences learning from physicians have only cemented this goal. During a recent shadowing stint with a neurologist, I encountered a child whose file described him as a “bad kid,” a constant troublemaker who had recently lashed out violently in school. The doctor uncovered a history of abuse by the mother, which included drug abuse during pregnancy, as well as spasms that he thought could be seizures associated with such drug abuse. Just weeks later, it was clear that the prescribed medications had worked. The boy’s behavior had reversed completely; he was performing well in school and was much more attentive than during his first visit. It was as if a veil had been lifted from his eyes and seeing him smile for the first time made my chest feel like it was going to explode. In seeking to tip the scales, there is no force more powerful than that of a life renewed. I want to ensure that no child like him is ever dismissed for reasons beyond their control and that everyone is always given the chance to be everything they’re capable of.
Other experiences were equally affecting. While shadowing at a local emergency department, I noticed a particularly active doctor and asked if I could shadow her. I spent the rest of the night chasing her from room to room as she expertly handled her many patients. She was both very compassionate and incredibly skilled. Despite her impressive stature, she was never imposing and she was always quick to comfort her patients by telling a joke or easing them into an encouraging conversation. I vividly remember how she sutured a man’s wound in a single fluid motion, sweeping the needle from side to side and knotting it in a big blur while I looked on in awe. My first attempts were miserable (luckily I only injured a piece of foam), but I practiced often under her direction and she soon labeled me “proficient” (an improvement over “dangerous”). Shadowing her inspired me not only want to be a doctor, but to be a great doctor.
My newfound drive towards medicine has helped focus my learning, with every course, lecture and concept settling in more firmly and with broader implications. Whether it’s the intricacies of neurophysiology or the huge variety of the body’s enzymes, what I’m studying now finally has meaning. This learning revolution (in addition to causing uncontrollable dorky outbursts of the “did you know?” variety) has expanded my interests in biochemistry, sparking my first foray into medical research. The almost Zen-like nature of delicate lab work has helped teach me the merits of patience, meticulous attention to detail, and steady hands.
Also rejuvenated is my central interest in neurology and neuroscience, where I redoubled my efforts as the vice president of my university’s CO-SIGN (College Student’s Interest Group in Neurology). Over the course of my membership, I’ve helped secure permanent status within the student association and organized community service projects, relevant guest speaker events, and shadowing activities for its members. As I moved up the executive board ranks, I learned how to entice and maintain an active membership and the importance of communicating sincerely and confidently.
I used to simply idle along a career path to medicine; now, ignited by real passion I can commit every ounce of my energy to perhaps the first real cause of my life. My philosophy is simple, “seek everything possible”, to experience the peak of what I am capable of. Only then can I fully know the limitless capabilities of my self. For me, that peak is medicine where I can satisfy both my passion for science, and my intense desire to help those who are suffering.
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Comments
Great post.
Non-medical person here. Your comment about the hippocratic oath and a discussion on another blog recently about naturopaths inspired me to look up the hippocratic oath. I was under the impression that all physicians had to take it. I learned that’s not the case, and that the original contains some strange stuff and isn’t the one used today. But that’s a topic for another day.
“A doctor is responsible for the health and life of his or her patients, a task that permits no gray area.”
I’m certainly glad you feel this way. I’ve always been curious, are there really no gray areas for most physicians? Is there disagreement on plastic surgery, breast augmentation, liposuction and sex reassignment, for example? These seem like situations that some doctors might find incompatible with “do no harm”.
Is it the general consensus that these procedures do more good than harm, or is there considerable disagreement, or is there a majority of doctors who take issue with the minority who do some of these procedures?
I hope this doesn’t sound judgmental. I had cosmetic rhinoplasty myself, so I can certainly understand the arguments for such things. But I’ve always wondered how much consensus there is on these topics.
Shae
Apr 19, 02:44 PM #
Hi Shae,
I think the oath is just a tradition these days with no real legal force. But, I think that tradition is what gives it alot of power on an individual basis. You’re right that the original version isn’t quite PC anymore (mentions euthanasia and abortion), but there is a modern version.
I think in the cases you mentioned, the doctor has the informed consent of the patient and they’ve both assessed the risk involved, benefits, etc. What’s black and white is when the doctor’s interests aren’t completely behind the patient’s well-being.
Thame
Apr 20, 08:53 AM #
“What seems to motivate many students now isn’t a passion for helping people, it isn’t an unfailing dedication to the art of medicine, it’s comparably trivial things like money, recognition and lifestyle.”
What is trivial about money, recognition, and lifestyle? I think those things are great! Personally, if I was in the hospital for something, I would rather have someone that cared more about their skills than care about me because I think caring about me would cloud their judgment. If given the choice, I’d rather get the right treatment to get better with a good doctor over dying with a worse caring doctor, but that’s just me.Rob
Apr 20, 08:50 PM #
Comparably trivial. The task of helping people shouldn’t be secondary to making money.
They don’t care about their skills though, they’re willing to prescribe drugs and procedures you may not need just so to run up the bill. Their skills (and your health) are exactly what they're willing to sacrifice.
Thame
Apr 21, 12:21 PM #
I kind of doubt that most doctors prescribe drugs and procedures just to run up the bill, although I’ve had a dentist recommend a very expensive mouth guard to keep me from grinding and I think I could get a cheaper over the counter version… but anyway, I see your point. It would be a real shame to experience being treated by a doctor that only wants money without any care about the patient. I imagine they might get caught and turned in for malpractice if they went too far though. I would hope that doctors that get the best job done at the least expense would be rewarded for it. Perhaps with more trivial money? Just kidding, kind of. Anyway, what a world this would be if everyone was passionate about what they do and not only going after a particular “lifestyle” As a professional orchestra musician I see this similar bad attitude all the time. Caring much more about the pay and how bad our conductors are over the quality of the music we make. Perhaps it is the era we live in today. It’s probably related to pressure from parents to follow their dreams for us instead of our own dreams for ourselves. So we are left with a generation of people living in their parents’ dreams excused by this generation because of the “lifestyle” they get. Anyhow, I personally have the internet and so I can do a little research on what doctors are recommending to me so I can get a small chunk of information from another source before going through with it. Thank you for this insight, as a pretty strong skeptic of most things, I usually trust doctors fully but now I’m thinking I should perhaps be more cautious.
Rob
Apr 21, 08:44 PM #
You bring up a really great point with:
The doctor-patient relationship is sacred and requires complete trust for the doctor to learn what he or she needs to make an effective diagnosis, and for the patient to actually follow through on the doctor’s plan. […] If doctors are in any way influenced by pharmaceutical companies, how can patients be sure that they actually need the drugs they’re given?
Could you expand on the extent to which this influences not only which drugs are given, but also why they are given? That is, is it possible that there is an epistemological impact resulting from pharmaceutical dominance?
If we look at this from a mental health perspective: considering the gigantic increase in disorders from DSM III to DSM IV, and the incredible proliferation of prescription drugs, we should ask the extent to which it is just the practitioner’s fault of “just being in it for the money”.
Considering the state of health insurance—even in my native Canada—and the cost of alternatives, perhaps we need to look to a greater political economy of applied medicine for the answers.
pouthouse
Apr 22, 08:42 AM #
I’m really impressed by your post. Sounds like you will make an amazing doctor. My PCP retired (basically left his practice) because he felt he could no longer handle his patients the way he wanted due to demands made by health insurance companies. I believe money was an issue.
Off topic but I wonder what your thoughts are about the role your website will or can play in treating your future patients.
michelle
Apr 29, 12:29 PM #
Yeah, it’s definitely a minority, but the practice seems to be getting more common with current residents and students. I seriously doubt the AAMC would have published a study so heavily emphasizing “lifestyle” as the one I linked above 20 years ago, but it’s common today.
I definitely didn’t mean to scare you, but it’s always a good idea to get a second opinion. There are also a number of sites online that aggregate reviews of physicians, so you can see what some patients think of their doctors.
Hi pouthouse. I’m not sure if I understand what you mean by “epistemological impact”, but if you’re talking about influence from pharmaceutical companies then I definitely agree that it is a big factor.
The separation, consolidation, and re-separation of subtypes of AD(H)D among releases and revisions of DSM III, IV are particularly worrisome. Reports of the condition have tripled over ten years (and spending increased by a factor of nine), which suggests there was either significant pressure on physicians or less diagnostic selectivity. Either way, it is the patient that suffers, and it just seems shocking to me that children (from age 3) can be given such powerful stimulants.
Thanks Michelle. I haven’t really thought about that much (it’s a ways off :D), but having an open, public line of communication can’t hurt. I could present relevant news and advancements in a more digestible format and help keep patients up to date.
Thame
Apr 30, 09:59 AM #
Hi,
The reading was interesting, It is nice to reflect about ones motives. Not very many people do that.
I decided to become a doctor when I was nine, being treated for appendicitis.
What I like about the job, now, is the instant feedback I get from patients and the feeling of being good. Even here in Norway we are paid ok, but that is of minor importance.
I guess I could do more for peoples well being overall having another job (teacher, economist, whatever), but that would not satisfy me to the same degree.
So my choice, like yours I guess, is egoistic. I was raised to work hard for the benefit of all. I continue to do that and I reward myself by thinking at the end of the day: You worked hard, you did your best and few would have done it better than you.
Einar
May 22, 04:23 PM #
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