Monthly Archives: July 2006

If the extent of “premed” student-bashing in college is any indication of future career experiences, I’m in for a rough ride, as are the rest of my future colleagues. It’s easy to pick on the premeds: the stereotypical premed is cut-throat, aggressive, unscrupled, doesn’t play by the rules, and spends all of his or her time studying in the library or cooped up in his or her room, studying. “Bookworm” has too innocent a connotation. There’s something very seedy and almost evil about “premed” that oozes off the tongue when you say it.

Personally, I find this stupid. A lot of the sentiment stems from a mixture of jealousy (of future salaries or prestige), inadequacy (at feeling unambitious or not hardworking in comparison), and skepticism (of the claims of premeds, that they “just want to help people”). Justified? Maybe, maybe not. At the very least, college students who attempt to find a career in medicine (as a physician) have a hard road to travel, some harder than others (if they’re not born into relative affluency or blessed with good schooling). They’re typically ambitious, hardworking, and probably appear one-sided. However, you see what you want to see, and for me, I see a lot of people who genuinely want to do something productive for society: people who want to relieve suffering, find cures for terrible afflictions (or as Jon Stewart put it, “terror-ble diseases”), and show that they care about other people (and that they’re willing and capable of doing something about it). Fast-forwarding a decade or so of medical training later, does this skepticism and criticism originate in questions of personality and professional approach or questions of qualification or erroneous judgment?

I do think that the principle of using reason is important. In many cases, particularly with people who have spent a lot of time in an academic environment that stresses skepticism, I think that many people choose to be skeptical but fail to maintain a perspective of the larger picture. For example, when you go to see your doctor, how do you communicate with him or her? How do you approach that interaction? Patients are encouraged (by a variety of parties) to take a more active role in their own care, and many interpret this as a call to do extensive online research, be wary of every word the doctor says, and seek second, third, or even fourth or fifth opinions (from other doctors).

How useful is this? Doctors have to be careful with their wording: they have to say, “It is my opinion that this is… and you should…”, leaving it up to the patient to have the final say. In many ways, this is what it should be: every person has the right to make their own medical decisions when provided with the best available medical advice. However, is this what most patients want? Having been a patient myself many times over a period of several years when I accumulated substantial amounts of higher education, I have found myself wanting more information about my illnesses and condition, but not necessarily doubting what the doctors say. I have admitted to myself that I don’t know everything about how my body and how diseases work. I also realize that doctors don’t know everything either, but it’s always clear that they know more than me, the patient.

This suggests that they will always have a better judgment on health matters, with one important caveat: this judgment relies on the patient’s willingness to provide all of the necessary information. In the TV show House, the title character, a disgruntled and misanthropic physician, repeatedly tells his protéges that “Everybody lies.” And in the universe of the TV show, this is the universal truth: in almost every episode, the complicated medical cases at hand could be solved within the first five minutes of the episode if the patients had taken the course of full disclosure. But this is a difficult question for patients? What information do doctors need to know? Matters of health, in our culture, are exquisitely personal and embarassing: most of us don’t expose our health profiles in public (unless we’re confident that we are supremely healthy, which is a rare find), especially if it affects our careers or our images in the eyes of others. However, patients should trust their doctors to be confidential with their health information (there are increasingly more regulations to eliminate “elevator talk” about patients and protect patient confidentiality), and they’re risking their health if they aren’t honest with their doctors.

It’s not just up to patients to change, though. Doctors also have to reevaluate how they approach their patients: Am I asking the right questions? How can I more quickly and effectively gain the trust of my patients? How do I make them more comfortable? What information am I missing to make the proper judgment call? For the most part, doctors have a very limited amount of time with each patient, so they need to work fast and make sure that they’re not making any mistakes or forgetting any important questions. In the best interest of both parties, both physicians and patients need to trust one another fully: to maintain privacy, disclose all of the needed information, and work together toward improving the health of the patient – the goal that both patients and physicians share and place as the first priority.

In a little over a week, I will be starting medical school and taking my first committed and substantial step (at the very least, with respect to time and financial commitments) toward joining the ranks of physicians in the U.S. I take this step accompanied by a number of friends from college and high school who share similar aspirations of becoming physicians, each with a varying distribution of motivation from each of the following: prestige, stable salaries, delaying the inevitable job hunt for another decade, and changing the world – whether through providing the best care for individual patients or changing medical practices and health care on a local, regional, national, or global scale. Like most students, a part of me thinks that I should buckle down, close the shutters, and study till the painful examination process is complete and I have a medical degree to prove my authority, ignoring any and all unnecessary bits of information. Physicians like to differentiate themselves from all other medical practitioners and academics who use the title “doctor”, and looking to the training process alone, it’s not hard to see why: few other professions require such extensive training, particularly with respect to the massive amounts of information that must be internalized in a very short amount of time. On top of the duration of the training and the scope of information covered, there are also the emotional, psychological, and physical challenges that test (relatively) young physicians-in-training and harden their physick-al fitness.

But what do we lose in the process of training? My first guess, preparing to step through the entrance, is that many future physicians lose perspective and connection. While they may learn a lot about the intricacies and ambiguities of medicine and health care, they sometimes forget where they came from or what that origin means. I think this disconnection plays out particularly strongly in the everyday manifestations of the doctor-patient relationship: like some college professors stuck in their ivory towers, some doctors don’t bother to truly communicate with their patients and help them understand what is going on with their bodies. However, sometimes this is due to time constraints, or fatigue, or simply believing that the patients don’t understand or don’t want to know. Hospitals and health care providers are now encouraging patients to take a proactive role in their own health care to make sure that they ask all the questions they have and have all of their questions answered. While this increased communication is needed, it also seems to breed suspicion and distrust: patients are ever-alert to see if their doctors are mistaken in their judgment, hence the complaint, “Everybody’s a doctor.” This tendency to distrust, of course, is fundamentally counterproductive since it frequently inhibits a single physician’s ability to direct the recovery of his or her patients.

On a fundamental level, the relationship between physicians, patients, and society must change and evolve to fit the needs of our society and its health care system. In the nineteenth century, American physicians practicing “heroic treatments” learned that the people could no longer blindly place their faith in the ability of physicians to always do what is right to heal them. Throughout the earlier years of the twentieth century with the advent of Germ Theory, physicians found that they needed to take a proactive role in promoting the scientific discovery of the origin of disease through public health policy and changes in medical practice in order to best serve their patients. Physicians can play numerous roles in society, but they also can be distrusted and heavily criticized, whether out of jealousy, mistreatment, or doubt about their underlying motivations. However, among the various factions and forces driving changes and policies in health care (the local, state, and federal governments; managed care organizations; pharmaceutical and biotechnology companies; hospitals; patients; and physicians), I believe it’s safe to state that physicians rank the highest with respect to emphasizing and prioritizing the needs of patients – in other words, all of us, collectively and individually.

With this in mind, it’s important for physicians at all levels of the health care system to be leaders: to be proactive in educating patients, supporting medical and health care movements, and shaping public policy in addition to their clinical care and research responsibilities. This is one effort on my part (along with the Next Generation) to press forward towards change for the better: in giving myself time to reflect on my medical experiences and training, a key aspect of medical education that is being reemphasized at this time, I hope to provide you with insight on medicine and health care and what it means to you. As a physician-in-training, I believe I’m ideally suited to this task: I still have the distinct perspectives of the patient, family member, and skeptic fresh in my mind while developing the knowledge base and perspective of a physician. Additionally, I will draw from my experiences as the Editor-in-Chief and Founder of the Next Generation, my summer internship at the New England Journal of Medicine (the most influential clinical research journal), and my experiences with patients, physicians, hospital staff, and administrators during volunteering and shadowing opportunities.

Alright, here I go! Thanks for reading, and please return often and much.

~ Sincerely, Apollo

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