Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Is medicine the “holy grail”(finding satisfaction in practice)?

Introduction

Every day I read  many letters and posts from undergraduate students who view a career in medicine as the ultimate prize for academic achievement. While this view may keep many pre-med students on the road to high academic achievement, a more realistic view of this profession and it’s practice is a better choice for keeping a strong perspective. It’s very admirable to wish to enter medicine to “help people”. In truth it is also admirable to enter medicine because you want to be well-compensated for the work that you perform but monetary compensation will not keep you bounding out of your front door every morning as you begin a 16-hour day with many challenges. Medicine is very much like the publishing of a daily newspaper in that you have to work through the hundreds of daily challenges and get them right while loving what you do. When I say loving, I can also add that along with that love there needs to be a bit of compulsion albeit healthy that has to be in your personality. In short to be an excellent physician, it’s about always being, to quote Larry King, “100 per cent when the light goes on” with the  light on practically every minute of the day.

Why good medicine may be difficult for even the most dedicated

It’s not just the surgical specialties where one has to “get it right” or life-changing consequences can happen for both the surgeon and the patient. Non-surgical specialties are far more difficult to practice at the highest level than most surgical specialties with the greatest hurdle for  the primary care physician, being the time constraints, though operating room time has always been expensive too and the knowledge acquisition challenges that would frighten many other professionals. A physician simply has to be adept at the mastery of many hundreds of pages of information that will prove crucial to practice on a daily basis, like no other profession. It’s the time between seeing patients that becomes a snippet of both “down time” and “breathing” time which keeps everything moving. Additionally, a good physician has to become adept in communicating with patients and staff in order to achieve the best outcome for their patients. It’s a narrow fence to walk on a daily basis with the unknown which eventually becomes a constant companion.

If the pursuit of a career in medicine is causing an applicant to attempt to significantly change their personality or ethical system, then medicine becomes a symptom of a problem that will make the practice of medicine very difficult. Medicine is not for every person either from an academic/scholarship standpoint or from a personality standpoint. With the length of the day and the complexity of excellent job performance, a candidate doesn’t have the time or the energy to keep up and “act” in order to fulfill some perceived “fitness” for medicine. My medical practice is as much an extension of who I am as a person rather than the product of any training that I received in medical school or residency. It didn’t make a difference that I entered surgery as my personality doesn’t allow me to act like an “entitled jerk”. There are too many moments when I find myself thanking my maker for getting through the day and not losing my perspective or awe of the majesty of every human being from that elderly veteran to a newborn with multiple congenital anomalies. In short, your patient’s and your community will demand that you keep a solid balance between humility and hubris.

When one starts to complain about “lack of a life” or having other “passions” outside of medicine before one enters the field, one should probably question whether medicine is the sound or compatible career path. If you find that you just love doing procedures and duties of the physician but you are constantly worried about your life outside of the practice (“I want to be home at 5pm every night”), you may want to consider pursuing the profession of physician assistant (less training time and less responsibility) rather than making a minimum 7-year commitment to medical training in addition to the life-long learning at a high level. If you can’t learn to find balance between medicine and your outside life within the boundaries of training, you won’t find that balance once your training is completed. By selecting the profession of physician assistant, the shorter training period coupled with a bit less responsibility might be an ideal fit for someone who has multiple interests outside of medicine.

I found quite rapidly that I needed to set more of a standard for study and scholarship outside of residency than inside. For me, combining teaching with practice was an ideal situation as my teaching forces me to keep up with my literature reading and the latest clinical practices for my specialty. For some of my colleagues, the work of practicing evidence-based medicine is a chore that they seem to avoid at all costs which can be to their detriment. There is a compulsion that tends to keep me focused on getting my work and reading accomplished each week. I generally find that I have plenty of time to pursue other interests outside of medicine within reason. As the daughter of a physician and coming from a family that boasts 10 physicians between aunts and cousins in every specialty, I can say that none of us suffered because our parents didn’t make every recital, soccer game or play. We learned to be self-sufficient, almost to an extreme point and we learned that the love and support of our parents was always present even if they couldn’t be at an event physically.

The “sacrifice”

Well, medical practice and medicine isn’t a sacrifice for me. It’s always a wonderful opportunity to test myself both mentally and physically. I have found that I have some innate qualities that allow me more ease with practice, such as not needing more than 4 hours of sleep, sleeping lightly – never missed a page, and having a generally upbeat disposition with an ease of communication. I simply adapt as best as possible to the situation at hand without much angst and worry. If I don’t believe I will enjoy working on a project, I don’t agree to do the project in the first place. I also have adapted to the thousands of changes that have become a part medical practice since I entered the profession nearly 10 years ago. For folks who have a difficult time adapting to change, medicine will be an extreme challenge. One cannot expect that medical school will teach everything needed for a modern practice nor does the medical school attended (as long as it is accredited and in the USA for practice in this country) matter much once you are done with that portion of your training. The habits learned long before medical school, such as, consistent and strong scholarship/study skills will make more of a difference in your practice as opposed to the school that you attended.

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23 June, 2011 - Posted by | academics, medical school

7 Comments »

  1. I know I’m here really late and I’m commenting on apost that is months old, but I had a desire to say something because it was so in sync with something I have been worrying about as of late and also – the article was written on my birthday! Seems to be absolutely made for me 🙂 Hopefully I’ll be able to keep my comment as short and concise as I can, but I wish to have your input (if you’re available) on my general goals and hopes. (IT’S BECOME AN ESSAY….. I won’t be disappointed if you don’t respond. It may be too long.)

    I’m currently a UG first year at a community college aiming to transfer out to UCSD or UCLA with a Political Science degree. The unconventional part is that I’m planning as a pre-med. I’ve seen people wear blank expressions at those two sentences the minute they stumbled out of my mouth. Obviously, there’s definitely the impression that I’m too young and decisions are always fickle at my age, and the whole part of being a Political Science major pre-med is fine but – a transfer student on top of that? Responses have varied from a gentle “maybe you should consider becoming a P.A. instead” or a snobby “you’re being irrational and silly”.

    The thing is, I’m aware of the situation, the alternatives, the risks, and I’ve thought of just doing something more conventional like going into law with my Political Science degree. My single mom’s a mental mess (dad’s whereabouts unknown), I stopped living with her since high school began, started working part-time non-stop since freshman year in high school, and I’ve been through my fair share of youth turbulence. Stability is something I always seek, and I value rational low-risk decisions for my life. So it’s shocking it’s pretty shocking to myself to find myself unemployed (yesterday was the last day of the two weeks of my two-week notice at the attorney’s office where I worked as a secretary for two years) and with no plans of getting a new job.

    When I was younger, my favorite toy was my first aid kit. When I was in middle school, I hesitantly considered becoming a doctor – did some research – got scared by the science-centric decade long curricula – and immediately trashed the idea. Decided to go into foreign affairs where my favorite subjects flourished – social science, rhetorics, and linguistics. In high school, lost my home, started hopping around different relatives homes, starting working, rebelling against society that placed me in hard circumstances and social institutions like school. Junior year, a friend scooped me out of my hellhole, gave me a home, helped me regain my passion for learning; I was always a curious person. Gained momentum immediately and did straight As in school with honors and AP classes but had a genuinely screwed-up record from freshman and sophomore year. All the administrators knew me – the principal knew me, they all liked me, and some counselors thought I was a miraculous success story. My GPA went from a 1.1 at the end of sophomore year to a 2.9 graduating (I used to ditch school all the time in freshman and sophomore year and worked under the table during school hours). I still had some fear that the person inside me that messed up those two years would come back again… my academic passions aside, I decided to set a pragmatic goal – decided to go into nursing, where I would be surrounded by the blood, the needles, the patients, the bandages, the things I also loved but would still be safe and “do-able”; I no longer feared the sciences, they were ‘do-able’ as well (and I started having a lot of fun with anatomy and bio); although not as fun as the social sciences and languages. But then working in an attorney’s office took it’s toll on me – I yearned the debates, the rhetorics, the fun snazzy discussions that my bosses would have and have with me.

    All in all, led to a community college – where I decided I would work on a Political Science transfer where I would be learning the things that interested me and I would have fun with a curricula that excited me. Usually though, those degrees end up in law school or are pretty un-useful in life (I don’t want to use the word useless). I decided I should go along with it though and aim for something in law, maybe medical malpractice. But the more I thought about it, the thought of sitting in a chair all day long terrified me. That was when I found out that you didn’t need a life science major to go to med school. I had originally thought becoming a doctor meant 8+ years of grueling hardcore science and then FINALLY clinical work + side continuing ed.

    My path is now set – study the academic curricula I want and am interested in, do the pre-med requirements on the side, and then get med school dealt with so I can have a career on my feet that I love doing – probably most importantly is helping patients, but beyond that I get to see blood, seeing the fascinating works of life, fix things.

    So that’s my background story. Now for my worries.
    I don’t want to take med school lightly. And I’ve done and still do a lot of research about the whole ordeal. I’m glad it’s challenging because that means that much more preparation for the huge responsibility of being in charge of a patient – that will live or die by your mistakes or correct decisions, but I’m thinking to myself, am I really up for it? I’ve gone through ALL that in my life which has made me a bit self-assured (aka cocky) that I’ve had my share of life experiences, so now I’m thinking that I should aim for everything I want and follow my dreams. But – what if I’m being delusional? I suck at waking up when I don’t get enough sleep, I constantly turn off my alarm, I love watching TV, I get my stuff done but procrastinate more than I should and I won’t get off that easily in med school I assume; I’m fine with gore and stink and nasty, I may wrinkle my nose but it’s all still fascinating. But – what if my brain won’t be able to take in all the information I need to, and in 3rd-year rounds, intern year, and residencies, there’s going to be a lot of kicking, pressure, and emotional stress – and I have a lot of patience but I don’t really have the thickest skin around and I’m pretty sensitive to what is said although I get over it as much as I can as fast as I can. What if I fail? What if I’m being SUPER delusional right now? At an age where every decision needs to be made with care and thought more-so than was ever necessary in high school, I’m just super anxious and worried.

    Any input?
    Thanks if you read the whole thing!

    Comment by Aimee Han | 24 November, 2011 | Reply

    • there are some major typos earlier on in my post – I hope you can excuse them…
      and I forgot to finish off one thought – I quit my job so that I can focus on school and extracurriculars I always wanted to do but never had a chance to – like student government and clinical volunteering.

      Comment by Aimee Han | 24 November, 2011 | Reply

    • To Aimee H:
      The subject matter of the major that you use for pre-med doesn’t matter. Everyone who gets into medical school does not have a degree in the sciences. I always said that if I were sure that I was going to become a physician, I would major in American Studies, minor in Spanish and take my pre-med science courses. The best major is something that is of interest to you and that you can do very well in academically. With that being said, you need to have a very high level of academic achievement. This means that you make sure that your pre-med science coursework is of sufficient depth and breadth that you are well-prepared for the Medical College Admissions Test (MCAT). This also means that you need to keep your uGPA (undergraduate GPA) well above the average for matriculants (currently around 3.7). Since it appears that you are in California, you need to be well above that 3.7 and you need to score very well on the MCAT as your state medical schools demand a high level of academic achievement.

      The next thing that you need to consider is that your career is in your hands. What others “think” of you and your career-decisionmaking does not matter as your career is your business. Preparing for medical school is not an ordeal but it is a long-term goal that must be kept in mind with every course and semester as you move through your undergraduate experience. There is little room for “do-overs” and “withdrawals” in this process thus you need to keep your goals in mind and keep moving toward them. I tell many of my pre-med students that preparing for medical school is like having 100 pounds to lose. The journey is long and constant but there is much to learn about ones “self” along the way. In short, do what you feel is best for your career and look past folks who do not support your goals. Good luck.

      Comment by drnjbmd | 25 November, 2011 | Reply

  2. Your very thoughtful post convinced me to really dig deep and make a very sound decision about medicine. At 33, I love hearing the stories about “Applicant X overcame adversity to become a doctor” or “Applicant Y pursued her lifelong dream at the advanced age of (**) to become a physician”. I feel the compulsion or obsession that you wrote about. I’m convinced that I have more to prove to myself intellectually and it seems medicine does have the appeal of making it to the very top. It was about proving to those who knew me as well just how high I could reach the echelons of academics and thus, socioeconomic status. Never mind my current situation in life. Never mind that indeed, I would most definitely give up a lot. Should I study optometry and risk working a retail job because of its current market? Should I study medicine to become an ophthalmologist or cardiologist and risk not getting the high USMLE I score necessary for those residencies?

    I made the mistake of pursuing a pharmacy degree, attempting to “change my personality significantly” and my ethical views regarding good medicine. How does a retail store sell cigarettes while advocating health? It is often said to pick a career that fits one’s personality as it tends to breed success. Yet, there are times, given these economic tough times, it may be best to just stay the course, put food on the table, pay the bills, don’t stray too far from your career path (medicine) as the years fly by.

    Less an applicant selfishly keeps chasing the ideal career after career. Less he/she becomes an old decrepit with little to show for it while working minimum wage and living from paycheck to paycheck. I know of someone who studied podiatry (this niche is not without its challenges) and decided well, despite the incurred indebtedness that she would go to great length to study medicine abroad. The main motivations: D.O. are not “regarded as true physicians” (supposedly they could not make the cut-off for MD schools) or podiatry is confused with “chiropractor”. Clearly, going about medicine possibly for the wrong reasons.

    Physician assistant sounds like a good alternative and I will look into it more in depth than I already have. Dentistry and optometry (though much less for the latter) offer opportunities for private practice. Being a clinical pharmacist is a possibility to work in a real healthcare environment and apply skills learned in pharmacy school. Your blog is indeed very thought-provoking.

    Thank you for your time in writing the posts.

    Comment by Hopeful Romantic | 25 July, 2011 | Reply

    • To Hopeful Romantic:
      It would seem that you look to medicine for a paycheck rather than looking to medicine for what medicine actually entails. While money is an OK motivation, medicine (if you can’t get into the high paying specialties that you seem to seek) can be the greatest “hell on earth” if you don’t get what you want. The odds are, that you are not going to make the USMLE/COMLEX (yes Doctors of Osteopathic medicine practice optho and cards too) that will enable you to get to the “big bucks”. You need only look at those folks who have actually done extremely well in their medical school coursework only to find that they didn’t get the USMLE/COMLEX (these tests are not taken over and over for a better score-one shot and you had better pass well) score that allows them to determine their fate. If you look at medicine, look at all parts of medicine not just the high-end specialties. The notion of “should I study medicine to become an opthalmologist or cardiologist” isn’t the question because you may find that those specialties are of no interest (once you actually treat some of their patients) to you or you find that doing extremely well in medical school and on licensure exams is easier said than done. There is nothing “romantic” here, it’s just working hard and working efficiently while working hard and complete mastery of a very challenging curriculum with little room for error.

      Comment by drnjbmd | 25 July, 2011 | Reply

      • Drnjbmd,

        I regret what I wrote was taken out of context. It only shows that I did not do a good job explaining myself. Allow me to deliberate just a little further.

        Ever since I could remember I enjoyed learning about the heart’s physiology. Perhaps, because of my love for physics, its concepts appeared beautiful and logical. Consequently, in grad school physiology, it was by far my favorite block. Every organ in the body is amazingly complex and beautiful in its own way. With ophthalmology where in the case of glaucoma, several researchers are figuring out how to allow the aqueous humor to pass freely through the trabecular meshwork into the Schlemm’s canal, thereby reducing intraocular presure. Again, because of my love for physics ophthalmology would seem like an ideal career path within medicine. In engineering even, we send robots into space but without cameras (robot’s eyes), scientists would have no idea what the rovers were looking at. The eyes allow many of us to connect with our soul mate, to salivate like a Pavlovian mutt at the sight of something delicious.

        There is an immense self-fulfillment in accomplishing something that is challenging. What is also inspiring is to read a fellow student like doctajay achieved his goals of orthopaedic surgery given supreme determination. What I like about your post is that far from romanticized medicine, hard work and constant pressure must be reckoned with and this kind of situation is far from the glamour of television medical shows of mostly boy meets gal. In addition, I like how you gave alternatives to being a physician that may be just as rewarding.

        Given this day and age, money will and must factor into any decision making regarding any career move. Certainly, the schools and loan sharks are getting more than their fare share. There is a reason why many medical students aren’t too interested in family medicine. In fact in a recent documentary and as is well documented, lack of pay and lots of paperwork can be quite discouraging when one accounts for all the loans that must be repaid. But, again, it does take an individual who really want to make a difference at the local level and perhaps that individual is doing what he/she always wanted to do in much the same way I’ve always loved cardiology and ophthalmology. If I matched into family practice, chances are I would enjoy it still (in fact it is one I think about).

        There is nothing romantic about medicine. There was nothing romantic when my gastric cancer stricken brother, being so young, suffered immensely day in and day out. However, the care provided in making someone feel better, the rigor of training to meet the complexities of the human body with sound judgement can be tremendously fulfilling. The engineers who designed the tools you use for your surgeries, I’m sure, derive great satisfaction in alleviating pain even if through the intermediary of a surgeon. The optometrist can feel great in catching a rising intraocular pressure and refer patient to ophthalmologist. In short, healthcare is a team effort and I’m well aware of that. By not pursuing medicine outright, I’m not settling for another career. I’m merely saying that at some point a decision must be made and that there is no time, like most premeds out there have a propensity to do, to stay the course.

        Given many circumstances in my life, I missed out on my first love of aerospace engineering. For a while, for me medicine was the “holy grail” of a career. However, I’m glad I was able to read your post that jolted a dose of reality of the real issues (the uncertainty of matching in the real career path of medicine, the very long hours, the very fine balancing act of a medical career and family etc) at play. Whether I ultimately decide to give medicine a go, I would have been armed and much better informed.

        Thank you for keeping me honest…

        Comment by Hopeful Romantic | 25 July, 2011

  3. Thank you for this sobering post. It has certainly given me a good reason to reflect on my decision to pursue medicine. I believe it is too easy to romantacise the field, a clear and honest perspective is greatly appreciated.

    Comment by Dawn Louise | 13 July, 2011 | Reply


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