It was a hot summer day when I dropped my daughter off to march in a local, small town parade. I remember the road being under construction and gravel under my feet as I walked to find a spot to park my chair and watch the parade go by. Another Mom from our group pulled up her portable chair next to mine. She mentioned that she was a nurse, and knew that I was a doctor. She had a question for me. Her daughter was considering going to medical school, and she wanted my advice. The Mother was hesitant to see her daughter go into medicine. Medicine has changed, and so many physicians seem so burned out. It seems like such a difficult path to take. She looked at me imploringly, and queried, “What do you think, would you recommend it? If you had it to do all over again, knowing what you know now, would you do it?”
I took a long breath and paused before I answered. She had questions and concerns of her own, and had been in healthcare long enough to understand the challenges better than most. It was the way she asked the question that really struck me. Would I do it again, knowing what I know now? That is a difficult question.
The truth is, I am no longer that naive, innocent medical school applicant who thought she could change the world. Just about every student applying to medical school has some variation of the phrase: “I just want to help people,” in their application. And we genuinely do. There is great opportunity to have an impact on our patient’s lives in very meaningful ways, and it can be a challenging, but rewarding field. I still feel it is a tremendous honor and privilege to be a physician. Patients come to me at the most difficult, vulnerable, and intimate moments of their lives. There is a resolute trust and moral duty that I cherish.
However, healthcare in the United states is changing rapidly. The corporatization of healthcare has had some very destructive effects on the doctor patient relationship, and has had a negative effect on our ability to care for our patients, as well as the health and satisfaction of patients and physicians, alike. I would advise anyone considering doctoring simply as a means to make money, to reconsider. There are easier ways to make a good living.
There is a great personal cost to doctors, far beyond the dedication of time and financial investment of medical school and residency. It is a sacrifice of our irreplaceable youth for the greater good. Being a physician has affected every aspect of my life, and has greatly impacted my family and my relationships, in irreparable ways. I’m not saying I regret the decision. But asking if I would do it all over again, knowing what I know now, is a different question.
There were people in my life who tried to warn me. I was a nurse before I continued my studies and went to medical school. The physicians I worked with tried to tell me, nicely, not to do it. At the time, I was incredulous. I didn’t understand why they were unsupportive. Was it that they couldn’t foresee me transitioning from the role of a nurse to that of a doctor?
Now I realize that they were trying to protect me. They understood what a painful journey it would be. To use an analogy from the Wizard of Oz, once you pull back the curtain, you can’t unsee what you have seen. They understood the kind of experiences I would have being placed in that role. There is a special kind of loneliness in knowing the suffering of people, and being the keeper of their burdens, while protecting their privacy, and having nowhere to go with all that pain. It changes you.
On the one hand, we need young, enthusiastic, idealists to go into the medical profession, as we did, with high hopes of making a difference and changing the world. That’s as it should be. We want to attract the altruists, the dreamers, the believers, and the optimists to what truly is a noble profession. We want the humanitarians who consider the practice of medicine their true calling, and treat it as their mission.
Unfortunately, the current climate of medicine in this country has affected our life’s work. Those of us who have been doing this long enough to see the impact of this change have trepidation about our own children choosing this vocation.
This Mom was familiar with the current state of healthcare, and had her own concerns. So what was I to do, should I reassure her, encourage her, or warn her?
As I considered her question, and have considered how to answer should my own children ask the same, I have come to some realizations.
Becoming a physician was more than just a job to me. I really did approach it as my passion, my life’s work, and my mission. I invested most of my youth studying and training, and seek to be a life-long learner, always trying to improve and grow. I did so because I consider it a great honor to care for patients in the manner that physicians are allowed to do. I am privileged that patients entrust me with their most grave concerns and delicate matters of their hearts, minds, and bodies. I have born witness to some of the most intimate moments of the entire spectrum of life. My patients have taught me about life, pain, tragedy, joy, faith, and love. They relied on me, hoped in me, and entrusted me with some of the most exclusive moments of their lives. I worked hard to prepare myself with knowledge, as if knowledge alone could bear the burden of that type of obligation. There was great sacrifice for me personally, for my family, and for those that loved me. Yet that sacrifice seems minuscule in comparison to the encumbrances my patients have had thrust upon them.
Illness and injury, pain, death, and disability are no discriminator of persons. To see suffering, and try to mitigate it, is at the very root of humanity itself.
There is another unspoken burden of physicians. There is far greater need than we can fulfill. No matter how much I study, how much time, energy, or effort I expend, there are suffering people whom I cannot help.
Meanwhile, the fleecing of the doctor patient relationship for profit, continues. For a long time many doctors wanted no part of the “business” side of medicine. It either detracted from their work, or seemed like a conflict of interest. It also probably wasn’t generally our best skill set. This provided a ripe field for exploitation, and more business minded people seized an opportunity for profit. Healthcare systems were quick to adopt “LEAN” processes and other efficiency targets, that truthfully are better suited for an assembly line of inanimate objects, and were never meant to be applied to the care of people. There are government mandates, complex payer systems, an inconsistent and unfair system, and a quagmire of a bureaucratic mess to wade through on a daily basis that have placed a chokehold on heart of medicine and suffocate the doctor patient relationship. That juxtaposed against the daily needs of our patients is enough to crack the very heart of a physician.
Faced with this dichotomy, do I harden my soul against the suffering of humanity to protect myself, or do I allow myself to become a cog in the great wheel of corporate medicine? How do I maintain my humanity, and continue to give the best of myself, help those I can, provide compassion to those I cannot help, jump through all the proper bureaucratic hoops, and not be crushed by the weight of it all?
There is a reason healthcare is historically so closely tied to religious organizations. There is a spiritual component, and a sacred duty that is not easily distilled into electronic records, financial balance sheets, and the cold metrics currently being liberally applied to the outcomes of care.
So my answer to someone that wants to take on the challenge of the practice of medicine in our current healthcare environment, is if you are steel willed, enthusiastic, and sincere, yes, please join us. The need is great, and we can use all the help we can get.