Morning Rounds: Why You Shouldn't Go to Medical School, Unless You Have To
TO YOUR HEALTH -
Thursday, July 16, 2015 7:52 AM
One of the more satisfying aspects of my career has been the opportunity to talk with many young people who are considering medical school.
I always find it very hopeful that so many capable, intelligent, compassionate people are willing to make the sacrifices they will have to make to survive medical school, residency training and life as a physician.
But I always ask them one question: "Is there anything else that you can possibly think of that you would be happy doing?"
If they answer, "Yes," I tell them to do it, whether it means becoming a Wall Street banker or an artist.
I tell them that because medicine requires the kind of sacrifice that people generally are not willing to make for a career, unless it is the only thing they can picture themselves doing.
Not because of the long hours, or because of the study, pressure and hard work. I tell them that because of the unthinkable consequences of being wrong, because no matter how good a doctor they are, they will never know enough. There will be mistakes.
As Director of the Emergency Medicine Residency Program at Maine Medical Center, one of my jobs was to interview senior medical school students who were hoping to become emergency physicians. Each year we received about 600 resumes and interviewed about 70 to match six new residents into our residency program.
One student asked me a great question that you might think would be a very common question. "What is the single most important characteristic you are looking for in an applicant?" Surprisingly, after interviewing hundreds of students, I have only been asked that question once. I had to think about it for a minute before I came up with what is unquestionably the right answer in my mind.
I realized it wasn't about being smart - anybody who had gotten through medical school was smart - and it wasn't about being a hard worker, for the same reason. It wasn't being a "go-getter," either. At that stage of the game, we actually look to rein in assertiveness more often than not.
The single most important trait in an emergency physician is compassion.
In emergency medicine, most of our patients are in crisis and time is limited. Providers have to be able to quickly develop a rapport with patients in order to get the information they need to make care effective.
Compassion, showing the patient that you care about them by listening without interrupting and taking the time to ask them how they are doing, is an indispensable part of being credible.
Compassion alone, however, is not enough; it has to come from a commitment to service. Everything you do has to be about the patient. And finally, and this tends to flow naturally out of that commitment to serve, the doctor has to be ready to lead the team treating the patient or just be a member of that team, depending on what will most help the patient.How does that look? In terms of popular culture, think "Scrubs" instead of "House."
In "House," the main character insults fellow doctors and patients pretty much equally. Not only would House be a team-killer in any hospital I have ever worked in, but he would alienate every patient he talks to, which would actually be fine with him because he assumes every patient is lying. Team? There is no team; there is only House.
"Scrubs," in contrast, is about the relationships that form and everything else that happens between medical emergencies. It is also about the insecurities and difficulty of being in a place where you have a lot to learn but still have great responsibilities.
There is something counter-intuitive about a zany comedy being more realistic than a serious medical drama, but with "Scrubs" that realism is by design.
The creator of "Scrubs," Bill Lawrence, wrote many of the episodes around the experiences of a college friend who is a cardiologist. He talked publicly about how his writers interview real doctors to get story lines.
The episode when J.D. hides in a closet to avoid being the first doctor on the scene when a patient's heart stopped beating? That one is taken directly from a physician's experiences as a resident.
In addition to the "ripped from reality" plot lines, what makes the show realistic is how it portrays the emotional side of practicing medicine, particularly how hard it is to deal with the fact that patients die and that sometimes things go badly.
Those moments when somebody dies balance the zaniness of the show. The way the staff of Sacred Heart have to move on after each death - and there is a fair amount of death - is part of the show's realism.
But as an emergency physician and someone who has spent a great deal of time thinking about what makes a good resident and what makes a good doctor, the part of the show I like best is the way everybody works together when the patient needs them.
As J.D. said in one of his voice-overs, "The best thing about this place is that when somebody's really in trouble, all the pettiness melts away."
Mark Fourre, MD, is an emergency physician and Chief Medical Officer of Lincoln County Healthcare, the parent company of Miles Memorial Hospital and St. Andrews Hospital. He also serves on Lincoln County Healthcare's Board of Trustees. Prior to joining Lincoln County Healthcare, Dr. Fourre was attending faculty at Maine Medical Center, where he developed the Emergency Medicine Residency Program and served as Residency Director.