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To what extent can physicians really make a difference on a systemic level?

numbersloth

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I've always been interested in science and healthcare, but more and more I'm worried that I'll be disappointed as a doctor. I'll see patients for whom I can do nothing -- I can't change their zip code, the trauma they went through growing up in a broken home, their seeming in ability to take their medication, their lack of access to safe places to exercise or healthy places to eat. Similarly, I won't be able to change the bureaucracy that is medicine or the corporate way healthcare is run so that we are paid to do unnecessary procedures and not paid to talk to patients.

I really enjoy helping others, thinking analytically, and learning about biomedical sciences. I'm just not sure I'll be able to make a lick of lasting impact in the field and I'm not quite sure how comfortable I feel about that. Anyone share similar feelings? Advice? Uplifting stories? I'm all ears.
 
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wholeheartedly

Epi Geek
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Beyond the Wall
I'm going to go cheeseball here for a minute

IMG_0787.JPG


Seriously though, you don't have to save the whole world or overhaul the system to make difference to someone. For all the negative BS in medicine (and there certainly is a lot of it), it seems to me there are a lot of little successes here and there. I was shadowing in oncology once and the nurses seemed like a pretty upbeat bunch. It kinda surprised me and I asked how it was dealing with so much loss. They didn't necessarily consider success always saving somebody, sometimes it was enough just to know they eased the patients passing.

But there are other options like public health where you can tackle things from a wider lens if you think medicine isn't a good fit for you.
 
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dchow

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I've been recently wondering the exact same thoughts as OP. I'm guessing MD/MPH is the best route to go to implement systemic changes - huge reason why GW is one of my top choices. I also know of MD/JDs who practice in the clinic AND get involved with health law which is pretty sweet (and time consuming).


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numbersloth

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Mar 26, 2015
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I'm going to go cheeseball here for a minute

View attachment 222601


Seriously though, you don't have to save the whole world or overhaul the system to make difference to someone. For all the negative BS in medicine (and there certainly is a lot of it), it seems to me there are a lot of little successes here and there. I was shadowing in oncology once and the nurses seemed like a pretty upbeat bunch. It kinda surprised me and I asked how it was dealing with so much loss. They didn't necessarily consider success always saving somebody, sometimes it was enough just to know they eased the patients passing.

But there are other options like public health where you can tackle things from a wider lens if you think medicine isn't a good fit for you.

See the thing is that I LOVE medicine and one-on-one care but I feel like a lot of medicine right now is inefficient and creates perverse incentives that, not matter how good a physician's intent, cause physicians to make choices that they don't want to merely to survive (i.e. pay off loans, support a family, keep their job, etc.). How can we as future physicians even begin to fix the broken healthcare systems and be the physicians we idealized when we started this process, not robots who are a source of profit in an increasingly incomprehensible system?
 

septalridge

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See the thing is that I LOVE medicine and one-on-one care but I feel like a lot of medicine right now is inefficient and creates perverse incentives that, not matter how good a physician's intent, cause physicians to make choices that they don't want to merely to survive (i.e. pay off loans, support a family, keep their job, etc.). How can we as future physicians even begin to fix the broken healthcare systems and be the physicians we idealized when we started this process, not robots who are a source of profit in an increasingly incomprehensible system?
Actually, you can have an impact, and in precisely the manner that you've outlined, but...you're right; you alone, or any individual or even group of doctors, is likely to have a systemic impact, given the current state of affairs. However, if you would like to practice in the idealized manner that obviously strongly resonates for you, consider the following: It seems your best chance of success in going to be realized in either FP or IM, as those providers have the most natural pathway to authentic patient interaction. If you're thinking ahead, and as you've mentioned, monetary pressures start to become exigent, you should know that many medical groups will provide you with a signing package that repays all or most of medical school tuition. In return, you will likely enter into a 3-year contract, during which time things may most definitely not be to your liking. However, at the end of that time, you are free to follow your convictions down whatever pathway you choose. While doing so may not prove to be as remunerative as other pathways, you will certainly not starve.
 

septalridge

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Actually, you can have an impact, and in precisely the manner that you've outlined, but...you're right; you alone, or any individual or even group of doctors, is likely to have a systemic impact, given the current state of affairs. However, if you would like to practice in the idealized manner that obviously strongly resonates for you, consider the following: It seems your best chance of success in going to be realized in either FP or IM, as those providers have the most natural pathway to authentic patient interaction. If you're thinking ahead, and as you've mentioned, monetary pressures start to become exigent, you should know that many medical groups will provide you with a signing package that repays all or most of medical school tuition. In return, you will likely enter into a 3-year contract, during which time things may most definitely not be to your liking. However, at the end of that time, you are free to follow your convictions down whatever pathway you choose. While doing so may not prove to be as remunerative as other pathways, you will certainly not starve.
sorry..."likely' in line 2 should read "unlikely."
 
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Doctor-S

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@numbersloth ... a career in clinical medicine is filled with plenty of positive outcomes, as well as negative outcomes. It's just the way it is ... in medicine, and life.

Instead of focusing on things that you feel you can't change at this time, you might think about other things you can do to make a difference.

These things do not have to be worthy of a Nobel Prize; little things as well as big things often make an appreciable difference in the lives of others (whether or not you earn a medical degree).

FWIW ... I agree with the Starfish Story posted by @wholeheartedly.
 
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Whoever destroys a soul, it is considered as if he destroyed an entire world. And whoever saves a life, it is considered as if he saved an entire world. Mishnah Sanhedrin 4:5; Yerushalmi Talmud 4:9, Babylonian Talmud Sanhedrin 37a.

Because of that, We decreed upon the Children of Israel that whoever kills a soul unless for a soul or for corruption [done] in the land - it is as if he had slain mankind entirely. And whoever saves one - it is as if he had saved mankind entirely. The Quran
 
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