AMSA's 2015 Annual Convention
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February 26 - March 1, 2015 

Discerning Your Path in Medicine

WHERE YOUR DESIRES, SKILLS LIE.

The New Physician September 2001
How do you know whether a career in medicine is an appropriate choice for you? At the core of every successful physician is a desire to serve others in achieving wellness through cure or prevention of disease, and there are limitless ways to achieve this. Yet medicine is not for everyone.


For most, medicine is a vocation; vocation comes from the Latin word for “voice.” One doesn’t choose medicine; one is called to it. Service is the work of one’s core or soul, and the call to medicine, with its heavy demands, should be in line with your unchangeable core traits and desires. Just as an acorn would be terribly frustrated if it tried to become an elm, you should not go into medicine unless you can grow into being a physician and not only withstand medicine’s demands but be energized by them. Parker J. Palmer, in his book Let Your Life Speak: Listening for the Voice of Vocation, writes: “Before you tell your life what you intend to do with it, listen for what it intends to do with you. Before you tell your life what truths and values you have decided to live up to, let your life tell you what truths you embody, what values you represent.”


Medicine is a profession whose key trait is selfless acts for the good of the patient or society in matters of health and disease. The difficulty of this responsibility is unsurpassed with the possible exception of the duties of public safety officers, armed services personnel or clergy.


Medicine is also a discipline. Discipline comes from the Latin word for “learner.” Western medicine is based on the mastery of a core of knowledge, behaviors, beliefs and decision-making tools based on the biopsychosocial model of disease. There is both an overt curriculum (the factual subject matter) and a hidden curriculum (the expectations of physicians by fellow physicians and by society). It takes daunting years of training to master the curricula. Those with other preferences might want to consider allied health careers, such as becoming a nurse or physician’s assistant. If you have no taste or ability for science, you should not choose medicine; other service fields, such as teaching or counseling, may be more suitable.


So if these are the core features of medicine, then what are the variables? A good place to start is to consider your talents and desires. Do you have an urge for inquiry, caring or teaching? If you have scientific interests, if you can translate the work of basic science into clinical care, medicine can offer you unlimited opportunities. The field’s gushing fire hose of scientific knowledge calls for those who can harness the flow.


And if you’re inclined to be mindful of a patient’s needs, values and individuality, you’re in luck. Medicine is always in need of humanistic care. Helping to fulfill these needs may simply mean refraining from interrupting a patient when he expresses his chief complaint. You can also fulfill your humanistic calling by focusing on improving a neglected area of health care. The etymology of “to cure” is the same as that of “to care.” While not every physician is capable of a great cure in every case, every physician is capable of small acts of great care (to paraphrase Mother Theresa). This ideal is remarkably consistent across cultures and the centuries—so is the need for excellent teachers of medicine.


And what about patient care? A wide variety of talents and tastes are needed here, too. The urge to fix or rehabilitate is at the core of the surgeon’s soul. The ability to make sense of patients’ stories and to explain (tell stories in return) is required of almost any clinical physician, especially those in primary care and psychiatry. Internists largely care for patients on the basis of abstract cognitive data—the patient’s symptoms, physical examination, blood tests, imaging studies, etc. Contrast this approach with that of dermatologists and radiologists, who work largely on the basis of visual data. Cardiology and endocrinology are good fields for those fascinated by physiology. In terms of their “customers” and breadth of knowledge, radiologists and pathologists are usually consultants or “physicians’ physicians” because they mainly serve other physicians. Anesthesiologists, on the other hand, serve physicians (usually surgeons) and patients equally.


In deciding whether medicine is the appropriate field for you, you’ll also need to consider the future of the field. As medicine becomes more technical and specialized, there will be an even greater need for physicians to be good communicators, good collaborators and relentless renovators of their skills and knowledge. In the past, physicians could largely work autonomously and sometimes rest on their laurels because of their sole control over medicine’s language, body of knowledge and treatments. Those days are long over. Greater access and choice is the future of every service field, including medicine. But compared to most of these fields, medicine and the individual physician have the widest range of freedom and practice, and have the greatest tradition of professionalism, openness, innovation and humanism.


The future of medicine is formed by this tradition. It was only in the 20th century that medical science allowed physicians to significantly alter the course of health and disease. The successes of science, as symbolized by the white lab coat, have perhaps separated physicians from the patient and the patient’s esteem. We need not be limited by this model, however. As in The Wizard of Oz, the isolating curtain can be pulled back and those serving health can work more intimately with those seeking health. The patient expects more than science and wizardry, just as Dorothy expected more when she learned the wizard was human. Being a wizard is a fine thing, but note that when the wizard asked Dorothy what she really wanted, he was acting as a human and true to his nature.


Listen to your life and discover where your greatest desires lie; see if there’s a field in medicine where you belong. Your guide will be when desire arises out of happiness—joy, discovery, respect, generosity—and not when it arises out of need—obligation, greed, fear, gain or even duty. In the face of desire, obstacles are immaterial; help will come, resources will appear, and your path will open before you.


Desire is happiness; satisfaction as happiness is merely the last moment of desire. To be wish and wish alone is happiness, and a new one over and over again.
Daniel W. Collison is chief of dermatology at Dartmouth Medical School. He specializes in skin cancer surgery. He considered a career as a literature professor before answering the call to medicine. Comments regarding this column can be e-mailed to tnp@amsa.org. Look for The New Physician’s next MedMentor column in November.