This Counterpoint is an open letter that was written in response to a recent Globe & Mail editorial (Think medical school is for you? You’re probably wrong) which took a pessimistic perspective on the pursuit of medicine as a career. This is the second in a series of replies written by the BoringEM team that will feature the perspective of a person at a different stage in their medical career. This piece contains the reflections of an attending physician, Teresa Chan (BoringEM Managing Editor, who has just completed her first year of independent practice). Teresa also urges all who want to join in on this conversation to tweet with us using the hashtag #DearPreMed. For part one of the BoringEM #DearPreMed series, click here.
Dear Aspiring Medical Student,
As an attending physician who applied to medical school a decade ago, I would like to thank you for considering devoting your life to medicine. Becoming a physician will take you down a long, hard road and require you to find strength that you did not know you possessed. Medicine is a challenging career that will require all the skills that you have learned publicizing plays for your drama society, planning that model UN meeting, and more.
Many of you are now assessing your MCAT scores and GPA scores critically while crossing your fingers hoping they are good enough to make the cut points for an interview. Let me reassure you, medicine is a career that is worth this stress. As someone who had scores on the cusp of the cutoffs, I want you to realize that you are more than just a collections of numbers. Remember, you cannot get in to medical school if you don’t apply. Take that leap of faith. The worst case will be that you do not get in. If that happens you can try again, or move on knowing that you had the guts to try.
Ms. Sinclair, the intelligent Oxford scholar that she is, is correct when she says that medical school is not for everyone. However, the difficulty with this is that sometimes you won’t know if it is for you until you are nearly done. Experiencing the reality of this profession is really the only way to know if you can cut it. We are unfair to you during the admissions process because we ask you to answer an impossible question: “Why do you want to be a physician?” Should we be surprised if you give us a canned, repetitive response? How are you to know about the inner quirks and subtleties of our profession, when we have such a locked-down, private culture.
Some of us have been brave enough to write about our culture. Samuel Shem’s House of God revealed much a generation ago. More recently, Drs. Danielle Ofri and Atul Gawande have penned great works that will give you insight into the worlds of medicine and surgery. I must confess that, as a 2nd generation doctor, I grew in what Ms. Sinclar calls the “Cult of Aesculapius.” My father is a physician, and I owe him a debt of thanks for providing me with an insider’s view of this profession. Because I grew up on the fringes of medicine, saying “yes” to it was ultimately much harder. I grew up thinking that it was normal to be at work 1-in-3 nights. Many a Saturday morning with Dad meant sitting at the nurses station eating cookies while he rounded, or bringing my frazzled and tired father his pager during a stretch of 1:3 call.
“Daddy… your pager is beeping again!” I would whisper in his ear as he was sleeping post-call in his bedroom, having just returned from a night at the hospital.
This was the mental image of what my life might be like, as I hit the dreaded ‘submit’ button on the OMSAS website nearly a decade ago. When I finally entered clerkship and residency, I thought that my background had somewhat prepared for the realities of a physician’s life.
And yet… I was still surprised.
I was surprised by how much I love this job and by how much I enjoyed serving the people that into my emergency department. I am continually surprised by the responses I get when I sit down and ask my patients the question: “How can I help you today?” If spoken with sincerity, those can be some of the most important words they hear. With those words, you join the people in front of you in their questions, burdens and uncertainties. You are given a chance to help them along their journey through the healthcare world. You are granted the privilege of entering the lives of people who have waited for minutes, hours, or days just to hear your opinion. If you become a physician, you too will be given this privilege. However, you will also take on great responsibility.
Failure has many faces: It’s not always a grade cut off
If you’re anything like me, you’re not a perfectionist. (Anyone that has seen my apartment will attest to this fact.) Sure, you can probably achieve the things you want most when you try your darnedest, but you have also learned that not everything is under your control. This is a good lesson to remember when you are faced at 3am with the fallen faces of a grieving family or parents at their wits end trying to care for their inconsolable crying baby.
Failure will look different in medical school. Due to a combination of fear and effort, you will very rarely ‘fail’ in the classical sense. But you will make mistakes. If we’re lucky, we will grant you admission to medical school when you have previously made enough mistakes to be wiser and better for them. Through your career, you will make more mistakes – and you will have to learn to live with them. However, your senior residents and attending physicians will be there to support you! We are your safety net. (Don’t tell my medical students this, but when I am on shift with them, I am constantly checking on their patients when they are not looking to ensure they have the correct diagnosis/treatment.) Errors are debriefed and near misses are addressed constantly from the time beginning of your training until you are a practicing physician. And even then, we have M&M rounds and chart reviews so that we can continually learn from past experiences.
Grey’s anatomy, ER, Scrubs – all these shows depicted the humanity of their physicians for a reason. While we sometimes stumble, we hope that the system catches our mistakes so we can redress them without harm to our patients. As Ms. Sinclair noted, Dr. Brian Goldman is a man who is quite wise in his ways. His TED talk is a legendary piece that is important viewing for both patients and doctors. It’s true, we do make mistakes and we need a way to shift our culture so we can talk about them. Hopefully, we will have good systems in place to make sure these are near misses rather than full ones. A system that is collectively competent that will have enough checks/balances/redundancies to ensure patient safety.
Remember that even during the admissions process you will have opportunities to shine and that a bit of stumbling is okay. It will be the cracks in that shiny façade and the quirkiness of that admission essay that help your application to stand out. If you try to hard to be perfect, you will miss the point of these experiences.
It is the best of times. It is the worst of times.
No amount of money or prestige can really compare to that moment when you greet one of your sickest patients from the ICU in the grocery store fully recovered, or when you hand over a new baby to a new mother to hold for the first time. No amount of money, prestige, or security will compensate you for the moment you have to tell a mother that her child has died. Suffice to say, this job is made up of moments from both the best and the worst parts of life and you will be forever changed by the perspective you gain and the role you are given in your patients’ lives.
I agree with Ms. Sinclair when she says this is not to a choice to be taken as a ‘de facto’ selection for straight A students. This job carries with it an enormous emotional and psychological burden, and one should be wary of these consequences. In addition to your career, you will have ‘real life’ happen throughout your training – marriage, divorce, childbirth, medical or psychiatric problems… life does not stop for medical school or residency.
In truth, your rationale for being a doctor will be a moving target.
To be honest, I am sure that the reasons I stated for ‘wanting to do medicine’ during my medical school interviews are vastly different from my reasons now as an attending physician. Whereas Ms. Sinclair had the laudable self-insight to decide not to attend medical school, I posit that there are many of you out there that might not know that you have what it takes. Caring for those in need is a noble goal, and as someone who convinced herself to take the plunge, it has paid off in more ways than I can count or remember. It is with a heavy heart that I suggest to you that you may not know whether medicine is the career for you until you are in my shoes. Unfortunately, as with most experiential learning, it is very difficult for me to explain to you how amazing this job can be.
This can be the most gloriously rewarding of professions. You will be afforded privileges and burdens that can be both elating and devastating. As Shakespeare wrote: “To thine own self be true.” Throughout this admissions process, be honest with yourself and continually test your assumption about why you want to enter this profession. Listen to those who share their stories, and see if you can see yourself engaging in the same. In medical school, be wary of your prejudices, biases, limitations, and capacities. Some of you will feel that you were born to handle the chaos of a busy emergency department, while others will find a less frenetic specialty to be your life’s calling.
And at some point, ‘medicine’ may no longer be for you.
Personal reflection and self-exploration with friends, families and academic counselors will help you to choose the type of medicine that is best for you. Throughout your training and beyond, you must to continue to be honest with yourself. At some point, that might mean saying that medicine is *not* for you… and that’s okay too. Health & psychiatric problems can pop up at any time. Later in your career, physical or cognitive limitations (especially age-related ones) may change your abilities. Knowing when to stop being a doctor may be as important as becoming one. I have had colleagues finish their MD degrees and become executives in pharmaceutical companies, leaders of tech start-ups, and politicians. Your MD degree does not oblige you to a career as a medical doctor for forever-and-ever-till-death-do-you-part. You will always have a choice, though realistically, it may come with a significant financial burden (e.g. medical school debt) or just later in your career. In the environment I have described it is no wonder that Dr. Goldman and Ms. Sinclair worry about physicians becoming “burnt out.” Perhaps counseling people to assume different roles and careers when the one they hold is no longer suitable is something that we can do better as a medical profession.
Hopefully, through more honest conversations like this BoringEM #DearPreMed series, you might have a slightly more candid glimpse into this profession to which you aspire. Good luck with your choice. It is a difficult one.
Teresa Chan MD FRCPC
Managing Editor, BoringEM