Is medicine a choice or a calling?

Over the last couple months, I have often been asked what I plan to do as a recent college graduate. My response has been that I will be attending medical school in Chicago.

“Oh! Medical school!” many exclaim as their eyes light up, “So you’re going to be a rich doctor.”

This response as well as most others I have received seemed to imply that medicine is an ideal profession if one is gifted enough to pursue it. Medicine has had the luxury of being one of the great professions within societies throughout history, along with practitioners in areas such as law and religion. Though some may argue that modernism has significantly transformed these historic societal roles, there is still a great deal of respect and prestige commanded by these positions. Perhaps my view is a bit romanticized, but I think there is value in viewing our future physicians as being called to the medical field to share their talents and abilities rather than being gifted enough to pursue professional prestige and a high salary.

This distinction seems particularly important for professions which deal in the treatment of people. To heal a person, whether it be his body or soul, requires both additional humility and more carefully defined goals. The former is well reflected in the old adage, “With great power comes great responsibility.” Work which affects the lives of other human beings carries with it additional moral and ethical weight.

The second requirement is a result of the former. If a car is broken, for example, it is usually easy to identify one’s options and the implications of such decisions. This is not the case for a human being with a diverse array of needs from physiological to psycho-social. Thus these professions require careful deliberations to determine appropriate goals and limits, and without those goals and limits, there is a greater risk for a lack of congruency, leading to disagreements about the correct place of such professions in a given society.

Approaching a field such as medicine as a simple choice may undermine the humility it requires and further complicate our attempts to define its goals and limits. Studies continue to suggest that a substantial percent of physicians are dissatisfied with their profession due to pay and a growing gap between professional and personal expectations. I think physicians and their patients may be expecting infallible medical professionals who operate independently and achieve financial benefits, whereas modern medical practice continues to demand collaboration and greater humility.

If I felt that I chose medicine to achieve some personal gain, I would be more likely to expect personal benefits which outweigh my sacrifices. Approaching the medical field as a calling shifts one’s focus to the positive impact one can make in his/her community, which may add both to the satisfaction of medical practitioners as well as their patients.

Before the remarkable technological growth of the last century, the medical field was limited in its power. Today nearly every known condition has a course of treatment, many with high rates of success. This newly obtained power has sparked a number of debates over the last few decades about the proper limits and goals of medicine.  It is curious to me that conversations surrounding healthcare reform seem primarily concerned with money. It seems that for many economic concerns define the proper place of medicine and we must simply balance affordability and access with innovation.

This cannot be right. Surely we would like to believe that our physicians sincerely care about our well-being and are not simply trying to maximize their profits by balancing our demand for ‘caring’ with their supply. For this and many other reasons, medicine is unique and economics alone will not provide us with the insight we desire. Rather than struggling to answer each ethical dilemma facing modern medicine individually when they arise, I think significant insight can be gained by attempting to trace these dilemmas back to their source and then posing more global questions.

To do so, let us compare the field of medicine to religious institutions. When a young man decides to become a priest, for example, we expect that he felt called to such a life. Yes, he likely could have pursued different professions, but he felt a pull, perhaps even a duty, to become a priest. When his parishioners seek his counsel, we would expect him to be humble to the power of his position and to provide guidance which would best serve the souls of those individuals, according to their common beliefs. The limits and goals of his profession are clearly defined by the doctrines of his religious institution. Although he serves his parishioners, he is not expected to tell these individuals what they want to hear so much as what they need to hear according to the teachings of their church. Medicine shares similar requirements for humility and clearly defined goals, yet we tend to approach this field quite differently.

Perhaps there is something to be gained by asking ourselves to what set of rules and principles should our future physicians answer? I would suggest that physicians should be servants of health and that health be the goal and limit of medicine. Of course defining health in a given society is no easy task; but if such a definition was achieved and universally accepted, I believe patients’ and physicians’ expectations may converge through this understanding, facilitating better patient-physician relationships and overall healthcare.

Much like the priest and his parishioners, patients may instead trust their physicians as servants of their health rather than prestigious professionals hoping to make a lot of money or powerful crusaders against death. Physicians may also face less ambiguity and greater satisfaction serving the health of his/her community rather than striving to achieve a return for their investment. Furthermore we may find ourselves agreeing on more of the tough, ethical dilemmas facing modern medicine.

Thus I conclude not with a magic answer but set of broader questions and a calling to physicians and patients alike to work towards a better understanding of health in our society.

Eric J. Keller will be an incoming medical student.

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  • Dave

    Medicine was absolutely a calling for me and one that I answered after many years in another completely unrelated profession. I credit much of my happiness with my motivation for entering the field and many great experiences have grown from it. If you remain kind, humble, and devoted to serving others, people will notice and you will stand out among your peers. Doesn’t hurt to be brilliant too, but brilliance just means you understand something in October that everyone else gets by December.

    • Eric

      Thanks for sharing your experience. I absolutely agree and hope that I am equally satisfied with the medical profession when I finish my training. What are your thoughts are the goals and ends of medicine (e.g. Should physicians use growth hormone to enhance the height of children who are simply short if the parents desire it, should we preserve life at any cost, etc.)?

      • Dave

        It’s tough to make any blanket professions because every situation is so different. I know that’s a cop-out, but I can think of situations where I would go either way on just the examples you gave.

        Maybe a good way to approach the goals and ends of medicine to define your process for finding them rather than the goals themselves. Medicine has a knack for throwing situations in your face that challenge any pre-set ideas you have — just wait until you rotate through the NICU! Ethics and theory are one thing in a classroom or over dinner, but quite another in those places where people are truly on the edge.
        I think you’ll be happy at the end of training and may even really enjoy the training itself. Most people come out of it as some version or who they were at the beginning. By the end of the first month (or week), you’ll already spot some classmates who you would never ever refer patients to as well as some you would even consider for a physician of your own one day.

  • Jeremy Sherer

    I admire your definite emphasis on humility. I would hope that others share this stance as well. I look forward to reading your next blog post!

    • Eric

      Thanks Jeremy, I think I have a good idea for another one… more to come….

  • Steven Reznick

    Extremely rewarding opportunity to help others in a field that requires life long learning. There is an economic side to it as well so just be certain that your future budget and business plan are in sync with the way you wish to practice and what you plan to do. Its not about being a rich doctor. Its about putting the patient first always.

  • buzzkillerjsmith

    The Mexicans think of doctors as being close to priests. I am very proud of that although I know I don’t rise to that.

    I never wanted to be a businessman. They’re good people (at least most of them), but I think that most of us docs want something different out of life. It is a privilege to help the sick, the current medicoeconomic foolishness aside. But the foolishness hurts.

    We’ll be here forever, in all societies. I take comfort in that. What we’re going through now is sad, and it is also sad that our profession has been infiltrated by those who value money above all else. Again, businessmen and profits have a place in life and I’m no socialist, but it should not rule all aspects of life. Health care, like food, clothing and shelter, should be provided to people in our rich country, even to people who just don’t live right, who don’t hold up their end of the deal. The poor we shall always have with us.

    We had a bargain with our fellow Americans. They would respect us and pay us well but not exorbitantly, and we would go the extra mile to help them in their time of need. That bargain has broken down over the last 30 years, to the detriment of doctors and patients.

    • Eric

      I definitely agree that a basic, decent level of health care should be available to all. Health is a very unique need which I believe Norman Daniels describes well in his book “Just Health.”

      What you mentioned at the end of your comment is what fascinates me and inspired this piece. I feel like there may have once been a better understood point of convergence in physicians’ and patients’ views of medicine. Another possibility is that there never was a clear, common understanding but now patients are more informed and medical technology is rapidly adding to the power and responsibility of the field. I’m not sure, but I hope further investigate and write about these more philosophical issues in my future career.

      Thank you for your insight.

      • Suzi Q 38

        Yes. During the 80′s, if I needed studies on drugs and/or conditions, I would have to go to the medical library of my local hospital.
        Now, I just type in the words.
        Sometimes I share the information with my doctor.
        I realize that h/she may not have the time that I do to research my own condition.

    • Guest

      Farmers and builders should see their roles as vocations too, they should just give everyone as much food as they want and whatever house they want, for free. Capitalism ruins everything.

      • Eric

        I agree and disagree. I hope everyone feels fulfilled in their career path and a large part of our construction of the concept of “fulfillment” is based on our concept of “self”. We seem to place value on our lives based on whether or not we feel fulfilled in or enjoy our activities. The thing is that fulfillment is largely based on social context, so if others and we view ourselves as being called to our career, we will likely feel fulfilled in it (to a degree). I did not mean any disrespect to other careers only that it may be more important for some careers’ practitioners to feel called to the service than others.

        That said, in response to your other point, I think socialism and capitalism both possess positive and negative attributes. Health care can be improved through the competition of capitalism; yet, health seems to be a basic need which should be socially supported. I guess a see a need for a balance since health seems to be, in terms of economics, both a private and public good.

        • Filo Bedo

          I don’t believe it is a one or the other blanket issue. I would argue that it is a calling for some and a choice for others. Character, personal values and goals (ambition), characteristics, perspective, morals and ethics – all play a role in whether or not someone feels called serve others in a medical capacity or one is making a calculated decision to be fulfilled in other ways.

          I am also entering into my first year of med school as a non-traditional (now 37 year old husband and father of 3 with a mortgage) and my reasons for pursuing a career in medicine are many and broad. Ultimately, I want to lead a life of purpose; this will undoubtedly be fulfilled through a life of service, challenge, and accomplishment. However, there are other reasons for my decision: dignity, self respect, economic stability, intellectual stimulation, etc.

          As the first to earn a bachelors, eventually a doctorate, I will be raising the bar and creating a new reality for my children as well as their children. This is a legacy that can potentially change the course – professionally, personally, as well as economically – for my family for generations.

          • Eric

            Thank you for sharing your experience and opinions.

            My goal in
            writing this piece was to suggest that disagreements about the goals and
            ends of medicine may be at the heart of many current bioethical issues.
            The choice vs. calling part of it was more of an example of how humbly
            surrendering oneself to a higher set of values can offer some direction
            in life. I was hoping to spark some conversations about the source of
            current bioethical issues rather rather than whether or not someone
            chooses or is called to do something.

          • Filo Bedo

            So you don’t feel those attributes I mentioned before (character, world view, etc.) play a role in how a physician practices medicine? I would argue that those things not only set one on their path, they dictate how one conducts his or herself throughout their career; those attributes, I believe are at the heart of the issue.

            I think Dave made a really great point when he stated medicine will challenge your pre-set ideas. As situations become convoluted and complex, and various value sets and opinions conflict in a given scenario, the integrity of your character will most certainly be tested and your qualities, both good and bad, will be exposed. Life, not just medicine, has a way of doing that.

            More specifically and personally, I have three children, two of them are boys. One is 13 and the other is 9 and they are easily both the smallest boys in their classes. As much as I would like to see them grow to be big strong men – this isn’t likely as I am average in height and mom is a very little gal – I would never give them growth hormones to achieve this end. I don’t believe I would ever do this as a parent or a physician. But that is based on my own values, my own world view, how I process information, and what type of society I want to live in.

            Should we protect life at all costs? Even at the cost of someone’s dignity and autonomy? Or worse, at the cost of someone else’s life? I say no, but don’t believe that is necessarily for me to decide.

            Should pharmaceuticals in general be a part of this discussion? Why are they so easily accepted? The introduction of foreign chemicals into a system that is based completely on chemical reactions is not something that should be taken lightly at all.

          • Eric

            With all due respect, I think you may be misunderstanding me. I most certainly feel that character, world view, or in summary, what John Rawls called one’s “comprehensive doctrine” all play a major role in how one conducts him/herself. I was explaining in my last response that although those ideas are related they were not really my focus in this piece.

            As a student of medical humanities, I spent a good deal of my time over the last couple years reading and listening to lectures about various bioethical debates in medicine. Many of the issues seemed to center around different opinions about the goals and ends of medical practice. For example, Leon Kass has strongly argued against the use of many biomedical technologies, whereas Arthur Caplan can be seen as representing the other extreme. Both of their positions seem largely based on what they see as the proper place of medicine in our society. Of course, the field of bioethics concerns a lot more than just debates over the use of biomedical technology, such as some of the other ethical questions your posed.

            These issues are very important and definitely deserve further discussion. The difficulty in taking one side or another, as you and others pointed out, is that everyone has their own comprehensive doctrine. In relation to healthcare, one of the best resolutions I have come across is Norman Daniels’ “Just Health”. Daniels used Rawls’ idea of an overlapping consensus, where we can agree on what we owe each other, and applied it the health care. Expressing and discussing these different philosophical positions help us to better understand medicine and thus improve its practice.

            As I listened to these different perspectives and read different positions, I couldn’t help but see some contrasts and guidance in various religious institutions. It seems to me that if we as a society could find an overlapping consensus with regards to our definition of health/disease (a whole other philosophical debate), we might find ourselves agreeing more on these other bioethical issues.

            I really was not, or at least did not mean to be, conveying my “pre-set ideas”. Rather I hoped to very briefly present my reactions to the various ideas and opinions of the medical philosophers I have been listening to/reading and relate them to my own experiences.

            My personal opinions on what it means to live a good/fulfilling life or why I am pursuing medicine and bioethics are whole different stories.

    • Suzi Q 38

      I wholeheartedly agree.

      In the last 30 years, a few doctors lost their moral and ethical compass. They money was just too important for these few.

      Also, other doctors became too cowardly and apathetic to make sure to point the errors out, in the name of decency, for the good of the patients.

      I used to respect all doctors. I needed their help and medical knowledge.

      I still respect doctors, but I do not believe all of them are good and smart enough.

      Some are born to be doctors, love their profession and spend each day caring for their patients in the best way that they humanly can. Thankfully, I have a few like this.

      Others are negative, don’t listen to their own patients, are too quick to bring out the prescription pad instead of being a “detective” and figuring out what is the source of the symptoms. They are negative and think they know it all.

      These doctors need to find something else to do.

      I

  • Sara Stein MD

    I’m sorry you lost me at “rich doctor” Still laughing. Best of luck!