Recently, I overheard a discussion between an established physician and an undergraduate in pre-medicine studies from a small liberal arts college. The physician tended to discourage the student from entering a medical career. This disturbed me greatly. I cant remember a single instance when I ever received anything but encouragement to pursue a medical career during my undergraduate years.
In a recent survey, pre-med students were found to be attracted to the field by the intellectual stimulation and the power to help others, yet most were also very concerned about being in debt, dealing with patients who might die, and the compatibility of medicine with having a family. Women students were more concerned than the men about having only limited time to become acquainted with patients on a social level.
The decision of students to forgo a career as a physician in this survey group was shaped by apprehensions regarding the years of work required in residency, the need to be on call, unacceptably low grades and the realization that other attractive career opportunities were available. Three quarters of them named organic chemistry as the single course that had affected their plans. I thought how unfortunate it was that a single course could contribute to eliminating persons who might otherwise excel as physicians.
As I continued to research this subject I found that there were striking differences in individuals with different socio-economic status. Pupils from lower socio-economic groups tended to hold stereotypical and superficial perceptions of doctors—medical school was seen as culturally alien and geared toward "rich students," and they greatly underestimated their own chances of securing a place in medical school and sustaining the course. They saw medicine as having extrinsic rewards (money) but requiring prohibitive personal sacrifices. Pupils from affluent backgrounds saw medicine as one of a menu of challenging career options with intrinsic rewards (fulfillment and achievement).
In most Western countries, medical students are generally recruited from the middle and upper middle classes and notably often from the families of physicians. Consequently, it is likely that many professional values, norms and traditions are intergenerationally transmitted within families with a member in the medical profession.
A Finnish study demonstrated that medical students tended towards certain personality traits: The open-minded, information-oriented students use self-relevant information given by others in the personal exploration of alternatives, whereas persons with a "foreclosed or normative" approach committed to certain goals and values without personal exploration and are eager to meet the expectation of other peoples and authorities. Consequently, these individuals' views tended to be more rigid and traditional. Students who have had more personal experiences, have had family members or friends working in health care, or have accomplished other studies before entering medical school usually, in turn, have adopted a more personal orientation to patient care, and these students who have had an opportunity to receive and explore more versatile views and experiences were much more open-minded to exploring alternative explanations and reasoning pathways.
Some things, like a clear set of values and an enthusiasm for learning, must be kept if medicine is to mean anything. Those who want to be good doctors must commit to a lifetime of learning—which means displaying, not hiding their ignorance. The sad truth remains that one-half of what they will learn in medical school will either be dead wrong or out of date within five years of graduation; the trouble is that nobody can tell them which half. So, the most important thing for them to learn is how to learn on their own. It is so important to aim at knowing how to learn, how to get useful medical information, and how to critically assess the information.
Lastly, when medical students have had a bad day because they are tired, stressed, overworked and underappreciated, they must never forget that things are much worse for the person on the cold end of the stethoscope. The best doctors are those who can begin to see the world as their patients see it.
Jeffrey A. Ratner, MD, is a board-certified physician specializing in pulmonary and internal medicine. He is in private practice in State College and is a member of the medical staff at Mount Nittany Medical Center.