Idealism and Medicine

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As an undergraduate researcher, I've been exposed to countless pre-med events I've organized or been invited to as part of my lab. This has put me before current medical students, and I've noticed something that is unnerving to say the least.

The main difference between premedical students, medical students and physicians I've met is a quickly decreasing idealism that permeates not only their personal lives (through cynicism) but through the underlying value they place on their professions, as well.

As undergraduates, we are bound to this idea of being unabashedly committed to this profession. Doubt, as a pre-med student, is a death sentence. If anyone even catches a whiff of humanity in your personal statement or interview, you might as well consider yourself rejected in advance.

Why have we fostered this culture of fanaticism around a job? Yes, medicine is noble—but no more noble than any other public service work.

Are we doomed to perpetuate this unrealistic and deceitful mantra, over and over again? As professionals working toward a common "good," why are we the first to lie to ourselves and others?

Just a thought.

 

[Lucca]

You are right that medicine is just a public service, but it is important that physicians, pre meds, and medical students believe in the profession and the ideals it espouses.

The alternative (and the reality for many, many members of the healthcare profession) is apathy. And apathy is a death sentence. Idealism is necessary in the young student. The young student should not arrive to his teacher already cynical and jaded about the enormous work that has to be done. What is often not appreciated is the what the enthusiasm, passion, and drive in the student does for the teacher. It's energizing, it's challenging, it leaves room for the teacher to feel like there is good work to be done in teaching this student. In the physician self-care literature the words "silent curriculum" are often thrown around and the "silent curriculum" is heavily informed by the personalities and outlooks that the teachers in the profession take to be their own. Cynicism, apathy, stoicism, overacompensation, emotional distancing, gratuitous sarcasm, a lack of empathy - all of this can be communicated by the way you work and depend more on your attitude towards the work than the work itself EVEN THOUGH what brings them about most often is the work itself. A plucky, idealistic but well-adjusted and self-aware student is cathartic for the teacher and necessary for the well-being of a learning institution.

Medicine is different than any other profession. It's long, hard, demanding, and the stakes are high. The same can be said for many other professions but not in the same way that the stakes are high in medicine. There are small but constantly berating systemic problems that usurp these stakes. Patient apathy, futility of care, lack of autonomy, professional politics, uncommitted colleagues - together, these factors contribute to the physician's alienation from himself; to the sense that the institution of which he is a part is unaligned, apathetic, or even antagonistic to his previously held worldview.

The most important realization for any human being to make and especially for healthcare workers in this day and age to make is, in my humble opinion, the discovery that the "institution" is only made up of them and no one else. There is nothing to the institution of medicine outside of the medical practitioners themselves. Sure there is business, insurance companies, the legal system, hospital systems, the government, etc but the institution of medicine is made up of doctors, nurses, PAs, and other healthcare practitioners and no one else.

It ought to be the duty of an academic medical institution to take the misguided and ill-informed idealism inherent in most of the pre-medical population and shape it into an actionable, directed passion for improving the medical field in some way. Such projects are incredibly difficult; they can consume an entire lifetime and thankfully they have done so in the past.

The alternative is apathy and preservation of the status quo. This path is much easier. It is easier under the rule of market forces and regiment of the government to fall into the lowest potential energy state of practice, far removed from the patient or your identity as a physician. However, this is not adequate, just, or even permissible if the institution of medicine is going to have any future whatsoever.

The first and easiest step is to build a strong, sturdy sense of selfe and a substantial world view. An idealist with a strong sense of self can synthesize his experience and change his attitudes and actions and even compromising occasionally on some of his ideals without becoming alienated from themselves or depleting their self-worth. To take things like grades, ungrateful patiento, insurance disputes, illogical and unfair hospital regulations, professional abuse to heart and let them change you little by little over the course of a very long career is to make the mistake that these things - all extrinsic to reason and circumstantial rather than immutable - somehow change who you are, what you value and more importantly what you OUGHT to value.

 

[PlaqueBuster]

To answer your question, we must take a journey back into the past and consider the importance of physicians and their role in societies. To keep this short and sweet, basically, someone with healing abilities has always held an important role in societies across civilizations and through time. They were respected, valued and idealized. And they were few in numbers. The training was long and arduous to keep the numbers achieving this postition minimal. This thought has carried into present day. I believe that we look up to physicians and fantacize their profession because society has been shaped into thinking this way for so long. Once you start experiencing the field as a medical student or practicing physician, your views change from idealism to realism. This is because you are not no longer assuming what this profession is, but are living it. You begin to realize that this isn't what you were told by the rest of society. Hence, why shadowing and lots of shadowing help separate this type of mentality in pre-meds.

 

[caffeinemia]

I'm confused. I though a "whiff of humanity" was good. Did you mean hubris?

 

[Just Call Me Doc]

Idealism can be a valuable attribute. It is what often drives people to push through difficult times when the immediate benefits are not readily apparent. While medicine is no more noble than any other public service work, it should be YOUR noble work. You need to be able to own it when the going gets tough.

The issue (as @Lucca alluded to) is that idealism often has a foundation built on naivety rather than reality. When the real-world starts chipping away at these fairy tales, since these are the only things supporting these ideals they starts turning into cynicism. If there is at least some foundation of reality supporting these ideals, though, they are often able to stand the test of time. As @PlaqueBuster mentioned, this is the value of shadowing: in order to expose pre-medical students to the realities of medicine and build that solid foundation. That is why most medical school prefer hundreds of hours of shadowing so that a student enter the professions with at least some sense of what they're getting into.

Like many other professions, medicine can be a long and arduous journey that requires extraordinary commitment. Evidence of a lack in passion or drive can cast doubt in a medical school's assessment on whether an applicant will be able to make it though this journey. Experience will invariably temper a persons idealism, so if you start too low you really have no where to go.

But this isn't a unrealistic or deceitful mantra. It should be a wake-up call to ask ourselves (meaning each and every person looking to become a doctor), whether we have a realistic expectation of medicine yet still have the passion and commitment, i.e. idealism, that will drive us in our pursuit. If we find we ARE lying to ourselves and others, then that's a good sign we should be looking elsewhere.

 

[NeuResurgens]

I've experienced an interesting dynamic in my own attitudes as a pre-med. I follow world events a lot, and I have developed a deep cynicism about humanity, looking at atrocities committed throughout history up until the ones we are seeing in our present time. I tend to feel like no matter what people try to do, other people will find a way to screw it up. But simultaneously, I have unabashed passion for the science of medicine in itself, and I feel like I can separate my love for medicine from my cynicism about people in general. Many of the problems in medicine just come from the inherent problems of humans, and so I feel like I can deal with those for the sake of working in the field I love the most. My idealism focuses on the science of healing and is able to withstand my feelings about human tendencies.

 

[NonTrad16]

The main difference between premedical students, medical students and physicians I've met is a quickly decreasing idealism that permeates not only their personal lives (through cynicism) but through the underlying value they place on their professions, as well.

I'd say this could apply to most other professions as well. The pursuit of medicine is a decade long journey for some, and the only thing to keep someone moving forward in life is assuming that 'it's worth it'. Idealist just changes to understanding. If you ask anyone about what they experienced versus what they expected, you'd probably get a hint of "Well, it's not quite what I signed up for." In engineering, medicine, military, whatever.

People who want to become professors pursue 4-8 years for a PhD (depending on science vs humanities), often a postdoc or two for 1-4 years, and then if they are lucky spend 5 years churning out grants, working endless hours, etc to become a professor. My local U had ~300 applicants for a tenure track job. They are pursuing a very similar dream. They go through it all to educate others, do basic research, but... the odds are long, and the path is waist high with BS.

I don't think that medicine is unique in the BS, but I think people may approach it more fanatically to begin with; I've known people to dream about becoming a Dr. before stepping into a University. Combine that with the huge change in circumstance from start to end (starry eyed youth to adults with bills to pay) and you're bound to get a change in perspective.

 

[TxsMed14]

As an undergraduate researcher, I've been exposed to countless pre-med events I've organized or been invited to as part of my lab. This has put me before current medical students, and I've noticed something that is unnerving to say the least.

The main difference between premedical students, medical students and physicians I've met is a quickly decreasing idealism that permeates not only their personal lives (through cynicism) but through the underlying value they place on their professions, as well.

As undergraduates, we are bound to this idea of being unabashedly committed to this profession. Doubt, as a pre-med student, is a death sentence. If anyone even catches a whiff of humanity in your personal statement or interview, you might as well consider yourself rejected in advance.

Why have we fostered this culture of fanaticism around a job? Yes, medicine is noble—but no more noble than any other public service work.

Are we doomed to perpetuate this unrealistic and deceitful mantra, over and over again? As professionals working toward a common "good," why are we the first to lie to ourselves and others?

Just a thought.

I did some research into this topic, and agree with the last comment that it is part of proffesionalization in a lot of fields, but doesn't have to be. if anyone is still interested, compiled it into a post with solutions from programs I've attended. Any thoughts/comments are welcome.

http://medicalschooldropout.com/index.php/2016/05/09/medical-idealism/

 

[laughingfrog]

this thread sucks

 

[TxsMed14]

this thread sucks

I read it a few weeks ago, and found it relevant/inspiring enough to write about. There's actually a of of published research on the issue.


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