Doctor …a choice

things I’ve said about the medical profession. But maybe in the back of your head, you were still thinking, “Well, even though it sounds like a bunch of bitter black bile, he does kinda sorta have a point.” In which case, I’ve almost certainly lost you on this one: “Whaddya mean you’re not helping people? Isn’t that what medicine is all about?”

Well, actually, yes and no. Sure, there is the immediate gratification of delivering a baby, fixing someone’s eyesight with LASIK, catching a melanoma before it causes trouble, or prescribing some thermonuclear antibiotics to kick a pesky bronchitis before it becomes lethal pneumonia.

But, depending on the field you choose, most of the time you’re not doing that. You’re treating chronic conditions that are self-inflicted: emphysema, obesity, cardiovascular disease, diabetes. Moreover, patients tend to be non-compliant — they basically don’t do what you tell ’em to do. In fact, you too are probably one of those non-compliant patients who doesn’t exercise more, eat healthier, and take pills as they’re prescribed. Anecdotally, 50%+ of prescribed medications are taken incorrectly or never.

So there you are, like Cuchulain the legendary Celtic warrior, wading into the ocean and, in your rage, trying to fight the invulnerable tide and improve the health of your patients. You pour all your earnestness, good intentions and expertise into it, and — not a whole lot happens. Your efforts bear no fruit. So you suck it down and move on, sustained by the occasional kid who does get better, that eyesight that does improve, that bronchitis that doesn’t turn into pneumonia. Win some, lose many more.

AND THE ONE AND ONLY REASON WHY YOU SHOULD GO INTO MEDICINE:

You have only ever envisioned yourself as a doctor and can only derive professional fulfillment in life by taking care of sick people.*

There’s really no other reason, and lord knows the world needs docs. Prestige, money, job security, making mom happy, proving something, can’t think of anything else to do, better than being a lawyer, etc are all incredibly bad reasons for becoming a doc.

You should become a doc because you always wanted to work for Médecins Sans Frontières and your life will be half-lived without that. You should become a doc because you want to be the psychiatrist who makes a breakthrough in schizophrenia treatment. You should become a doc because you love making sick kids feel better and being the one to reassure the parents that it’ll all be OK, and nothing else in the world measures up to that. Or as my general surgery resident put it, you should become a doc because “my dad was an ass surgeon, my big brother’s an ass surgeon, and by god I’m going to become an ass surgeon.”

But woe betide you if there’s anything else, anything at all, that would also give you that fulfillment. Because pursuit of medicine would preclude chasing down that other dream and a whole lot more — a dream that could be much bigger, much more spectacular, much more enriching for yourself and humanity than being a physician. Just ask John Keats, Walker Percy, Sir Arthur Conan Doyle, Giorgio Armani, or Michael Crichton (some of these guys being more alive than others these days). Or you can just ask me a few years down the road, by which time I should have a blog entry for that question, too.

*Also acceptable: You want to get into academic medicine. Pretty much need an MD or MD/PhD as prerequisite.

Update 1: To those who are wondering what I’ve been up to since the writing of this article — that’s a long story. Most recently, I’ve been writing books, including the #1 rated dating book on Amazon, The Tao of Dating: The Smart Woman’s Guide to Being Absolutely Irresistible. Check out also the very popular dating ebook for men and my other blog for more articles, as well as my HuffPost archive.

Update 2: As of 9/24/2011, there’s a Hacker News thread on this piece, with hundreds of intelligent comments from people with firsthand experience about the medical lifestyle. Check it out.

Update 3: In September 2012, a survey by The Physicians Foundation found that 6 out of 10 physicians would quit today if they could. Click on link to find what’s driving the trend.

Update 4: In Oct 2012, Jake Seliger of the excellent blog The Story’s Story wrote a magisterial article on why becoming a doctor is a bad idea, with many angles that I hadn’t even considered. The whole antitrust suit against the Match and how it’s basically an illegal trust and how the AMA bought off Congress to head off lawsuits was particularly sobering.

Update 5: I recently had the opportunity to speak to the daughter of the lady who was the dean of of my med school. She told me that her mom specifically forbid her from going into medicine. Did you get that? THE DEAN OF MY MED SCHOOL FORBID HER DAUGHTER FROM GOING TO MED SCHOOL. I don’t think there’s anything else that could validate my decision more. This means I win.

Update 6: Great article from the Wall Street Journal on 8/29/2014: “Why Doctors Are Sick of Their Profession” by Dr Sandeep Jauhar. May also want to check out his books Intern: A Doctor’s Initiation and his latest, Doctored: The Disillusionment of an American Physician, released Aug 2014.

Comment rules: There have been a lot of comments on this article over the years, so if you wish to comment, here are the rules: if you have an intelligent contribution to make, I’ll approve it. I’m not anonymous, so you shouldn’t be either. There’s no room for hate, spite or derision on this blog, so comments containing them won’t see the light of day.

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