We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.
Short Version: A desire to help others is a critically important trait for an excellent physician to possess. However, a desire to help others provides little reason to go into medicine ahead of a plethora of other careers which also provide significant benefits to others. Physicians do provide assistance to their patients of course, but the effectiveness of that assistance is variable and often overestimated. Medicine is an inexact science and there will always be some patients who are harmed despite theoretically optimal management. Furthermore, even for physicians who make every effort to provide the best care for their patients, mistakes will be made and patients will suffer the consequences. Overall, physicians do improve the lives of those they serve and have the potential to be very impactful, yet need to maintain awareness of their limitations.
Long Version: I consider a desire to help others to be a near-necessity for a competent, compassionate physician. Many things can be and are taught in medical training, but empathy – and the passion to utilize it consistently – is not. Medicine therefore seems like a natural fit for caring, intelligent individuals who want to use their abilities to do some good in their communities or the world at large, with a career that reflects that focus on benefiting others first.
Yet, medicine is far from unique in being beneficial to others. Within healthcare, there is a multitude of careers which directly benefit patients in need in exceedingly meaningful ways. Physicians rarely, if ever, act alone in their administration of medicine, nor would they be effective acting independently of other professions within healthcare. Nurses, pharmacists, social workers, dentists, medical laboratory technologists, medical radiation technologists, audiologists, speech language therapists, physiotherapists, occupational therapists, EMTs... it goes on. Patients don't always need help from a physician and rarely need help from a physician only.
Additionally, non-healthcare workers can have a huge impact on people's health. Many of the gains seen in health over the past century are not attributable to advances in medicine or the delivery of healthcare. Increased wealth, better working conditions, improved nutrition, and cleaner environments have all played significant roles. Future gains (or holds) in human health are very likely to continue to involve those working in these fields, whether in the public, non-profit, or private sectors.
Of course, human needs extend beyond healthcare, and there are many ways to contribute to others' lives. Jobs in local charities, social development, education, and policing are often considered to be in the service of others. Careers not traditionally though of as being for the sake of others are nevertheless invaluable in our society, such as farming, construction, entertainment, or even (some) financial services. The perception that certain careers help people more than others is just that, a perception. Similar to the discussion on prestige, such perceptions are often unfounded and apply to the aggregate. An ethically-minded, competent banker can be of significant help to their clients. An unethical, incompetent physician can be an immense burden on their patients. The individual often matters more than the profession when it comes to the effect, positive or negative, on those around them.
Nevertheless, by improving health, physicians absolutely make a positive impact on their patients. Medical advances have undoubtedly extended life and improved its quality. Physicians, acting to implement those advances, are a critical part of maintaining if not furthering that positive change in the world. There have been times in my training already where the positive impact of medicine could not be denied. A man 10 years cancer-free and officially declared cured. A father, admitting that he was at his limit and taking the first step in getting help for long-standing depression. A mother getting to finally take her child home for the first time after months in hospital. These moments stick with you and many more interactions will occur where the benefit to the patient is not immediately obvious.
Yet at the end of the day, how much of an impact will a typical physician have? Likely a lot less than expected. While human health has improved, as noted above, much of that is due to societal advances outside of medicine. Likewise, much of the benefits of medical advances can be attributed to non-physicians. Where physicians can take responsibility for gains in health, those gains are often fairly limited. Most interactions with patients will not result in meaningful change to their health. Some patients require no intervention. Others require a test that does not end up changing management. Others will undergo indicated treatment that, by chance, produces no benefit. That last instance is far more common than the public often believe; if an intervention has been demonstrated in high-quality trials to help 1 in 10 people who receive that treatment - meaning 9 in 10 will receive no benefit - it has a higher rate of benefit, not to mention a stronger evidence base, than much of what is done in medicine.
Medical interventions also come with risks and harms. The phrase "do no harm", often associated with the Hippocratic Oath (though it does not appear in the original text), is notably absent from the modern version I took when I entered medical school. There's good reason for that as to be a physician necessarily means causing some harm. To provide optimal care is to accept risk, so some negative outcomes are inevitable. Expected benefits should always outweigh expected risks or harms, but the element of chance does not always turn out in our favour.
To go a step further, all the above applies to a physician providing optimal care. That is, one who is making no major mistakes or errors in judgment. No physician practices perfectly 100% of the time. With luck, most mistakes will be minor or lead to reversible harms, but bigger mistakes happen too, even to the best physicians.
I want to leave this post on a positive message, because physicians do have the potential to do significant good in the world and, importantly, the profession is strengthened by those with altruistic intentions. I do want future physicians to come in with a degree of realism, however, as too often the ideals of medical students run up against the realities of current practice and idealism gets replaced by cynicism. Likewise, on the other side of the spectrum, some physicians get through their training continuing to overestimate their impact and become conceded, failing to recognize the important contributions of non-physicians within and outside of healthcare. Aspiring physicians are not wrong to pursue medicine as a way to help others, but as with the previous post on money, medicine is not the indisputably best pathway towards helping others and as a result, alternative careers are worth contemplating.
Yet at the end of the day, how much of an impact will a typical physician have? Likely a lot less than expected. While human health has improved, as noted above, much of that is due to societal advances outside of medicine. Likewise, much of the benefits of medical advances can be attributed to non-physicians. Where physicians can take responsibility for gains in health, those gains are often fairly limited. Most interactions with patients will not result in meaningful change to their health. Some patients require no intervention. Others require a test that does not end up changing management. Others will undergo indicated treatment that, by chance, produces no benefit. That last instance is far more common than the public often believe; if an intervention has been demonstrated in high-quality trials to help 1 in 10 people who receive that treatment - meaning 9 in 10 will receive no benefit - it has a higher rate of benefit, not to mention a stronger evidence base, than much of what is done in medicine.
Medical interventions also come with risks and harms. The phrase "do no harm", often associated with the Hippocratic Oath (though it does not appear in the original text), is notably absent from the modern version I took when I entered medical school. There's good reason for that as to be a physician necessarily means causing some harm. To provide optimal care is to accept risk, so some negative outcomes are inevitable. Expected benefits should always outweigh expected risks or harms, but the element of chance does not always turn out in our favour.
To go a step further, all the above applies to a physician providing optimal care. That is, one who is making no major mistakes or errors in judgment. No physician practices perfectly 100% of the time. With luck, most mistakes will be minor or lead to reversible harms, but bigger mistakes happen too, even to the best physicians.
I want to leave this post on a positive message, because physicians do have the potential to do significant good in the world and, importantly, the profession is strengthened by those with altruistic intentions. I do want future physicians to come in with a degree of realism, however, as too often the ideals of medical students run up against the realities of current practice and idealism gets replaced by cynicism. Likewise, on the other side of the spectrum, some physicians get through their training continuing to overestimate their impact and become conceded, failing to recognize the important contributions of non-physicians within and outside of healthcare. Aspiring physicians are not wrong to pursue medicine as a way to help others, but as with the previous post on money, medicine is not the indisputably best pathway towards helping others and as a result, alternative careers are worth contemplating.
No comments:
Post a Comment