Responding to a prompt from a patient-family partner course I took this year, Walk With Me.
I went into medicine for many reasons. Some of those reasons have been with me for a long time, such as my nerdy fascination for the scientific workings of the human body (what I would now call “physiology”, with my newfound medical school terminology). That fascination started at age 7, when I discovered the pupillary reflex by shining penlights into my little sister’s eyes. Another, similarly self-centered reason: I thought I would find the profession very gratifying based on years of observing my father, an ophthalmologist in suburban central Florida. What could feel better than building a relationship with your patients, helping them directly, seeing your actions manifest in the improved health of your patients, and being paid to do it?
As I grew and learned about the world in college, I realized the importance of economics and public health in their capacity to transform entire populations, and I leaned away from becoming a clinician and towards a career in health policy. But what brought me back—medicine’s raison d’être in my world (if I can use the term raison d’être in this way?)—was the wisdom of the unique experience of being a physician. To quote my medical school personal statement: “Economics taught me that the difference between a poorly-designed and a well-designed health system could mean the difference between thousands and millions of lives saved. But what constitutes a well-designed health care system? I lacked critical knowledge: what it means to give health care. The knowledge that comes from listening to patients describe their daily struggles as they aspire to live healthy lives; from observing physical and mental comorbidities wreak havoc upon patients’ bodies; from troubleshooting health emergencies for patients who are uninsured as a direct consequence of current health policy—these are intimate details to which physicians are uniquely privy.”
Some of those reasons no longer ring true. I’ve begun to learn that most of the time, the practice of medicine isn’t curative. It can be incredibly un-gratifying. Long hours, loss of autonomy in a world increasingly dominated by healthcare administration—even without those factors we collectively lump as “burnout”, I’ve learned how frustrating it can be for both patients and doctors to not know the diagnosis, let alone the cure, when there’s an expectation that the doctor will know the cause of one’s pain, the cure for one’s ailments. Isn’t that what the doctor went to medical school and residency and studied for over a decade to learn? I’m beginning to learn that in those moments of unknown, doctors can still help their patients through healing, something that isn’t always explicitly taught in medical school.
I’ve realized how incredible, and sometimes scary, the level of power doctors have over people at their most vulnerable moments is. This privilege confers critical responsibility on providers not just to “do no harm”, but to act in the best interest of their patients. Unfortunately, all too often (more so at a systemic than an individual level), these responsibilities are eschewed in favor of profit or other incentives. Although my original belief in medicine’s commitment to put patients first and help patients unconditionally might not hold true at a systemic level, it does make that raison d’être ring true for me more than ever before. We need physicians who know, intimately, their patients’ struggles—who commit to putting patients first—to also be fluent in the jargon of health policy and economics, and to stand up to a system that capitalizes on vulnerability. I have been surprised by the large number of Stanford health care providers I’ve met who have no idea how much their patients are being charged for their services or who don’t understand how billing works. It’s not necessarily a fault of their own: the system makes it very difficult for them to attempt to understand beyond high-level policy ideas. (I will also note here that the Walk With Me crowd is an exception; providers seem much more closely in-tune to patients’ practical issues beyond their immediate health concerns, and that has been very heartening.)
That fascination for the science still rings true, too. Anatomy was a good example from this year: I found myself marveling at the fact that I was cutting into a piece of skin that could have just as well been leather, nothing more—sawing through bone that crumbled to dust. But that body was once a collection of vibrating molecules that formed living cells and organized into a being capable of self-regulating, thinking, speaking; of growing up and making things; of having friends and family—of being human.