Bioethics Discussion Blog: Playing Doctor vs Being a Doctor

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Saturday, August 26, 2006

Playing Doctor vs Being a Doctor

When we all started playing doctor around the time we were in Kindergarten, it was all about curiosity. We learned how our bodies were the same as some and different than others. There was no responsibility for our actions or for our “patient”. The requirements for a licensed physician are much different. Curiosity and self-interest without responsibility is not acceptable. Unfortunately there are some physicians who are in practice, as reported by angry patients on this blog, where curiosity and self-interest trump professional behavior and patient responsibility. In essence, these physicians are only playing doctor.

Students are selected to enter medical school by admissions committees. I have never participated on admissions committees (my only experience was being interviewed by one many years ago). However, there are general criteria which are used including amongst others, college grades both science and non-science courses, medical school admission test scoring, references, social activities including humanitarian and medically oriented participation, how the student communicates their understanding of medicine and their interest in the profession and the general behavior of the student during the interview. But despite all the screening, wrong students are selected and finally end up only playing doctor not being one. Perhaps, the committees are looking at the wrong factors or asking the wrong questions.

I would like to challenge my visitors (most likely experienced patients) to provide us with their own criteria that they think would be very important ones for medical school admission committees to consider when they are evaluating a medical student for admission. Any suggestions? ..Maurice.

5 Comments:

At Sunday, August 27, 2006 10:23:00 AM, Anonymous Jaine said...

Maurice, it is well known that medical students are supposed to offer themselves up, during the admission process, as being well-rounded individuals. I was contacted by a pre-med student, several years ago, who offered to provide free tutoring for one of my child, in a specific subject of interest, in trade for a letter of recommendation this chap could use when applying to medical school. He needed X number of volunteer hours. He did a wonderful job of tutoring. However, I was fully aware that had it not been for his need to gather such letters the offer would not have been made. I know a female student (not a med. student) who joined a church simply because the church offered a scholarship she was interested in. She was willing to attend the church for several years in order to secure the scholarship. She ‘won’ the scholarship. My point? Students know how to manipulate the system and can pull the wool over the eyes of well intentioned people.

In the book “The Sociopath Next Door” the author, Martha Stout, offers an interesting insight that could be applied to many areas (outside of sociopathic behaviour) including the type of culture medical students and doctors work in and how it impacts the expression of certain traits. Stout outlines the impact culture has on the degree to which sociopaths feel free to express their genetic pull toward lack empathy and conscience. She makes note that, while all cultural groups have the same genetic percentage of sociopaths, some cultures actually encourage the traits associated with sociopathic behaviour, while others discourage it. She points out that the culture in the US rewards individuals for demonstrating traits similar to sociopaths whereas Eastern Asian cultures, with the focus being on interconnectedness between both people and nature, rather than individual gains, discourage the expression of sociopathic behaviour. The result being that it appears certain groups have fewer sociopaths because the culture suppresses the expression of negative traits.

Using this insight it would appear that what medical schools in North America do is demand, in a self-serving, money driven pro-individual culture, that med. students pretend they have traits that are in fact not part of the greater culture. Then, it appears, once they gain admission the real culture snaps back into place, in full force, and med. students are taught they are superior to the general population. My suggestion would be that medical schools spend more time examining the contrast between the traits they say they want and the traits they actually promote within the training process. Or, in other words, what is the real culture in medical school? Wouldn’t it be better to allow med. students to admit they are interested in becoming doctors for ego and money and then have the medical community help them adopt a new culture where they learn to become interconnected to the human race?

 
At Sunday, August 27, 2006 11:27:00 AM, Anonymous Moof said...

I feel that the previous commenter was a bit harsh regarging medical students, and by inference, physicians.

Although I don't know the people who were mentioned, stating as fact what a person would have done had they not been motivated by a particular desire is to judge them ... and perhaps even to err in doing so.

To carry things a step further ... is there anything wrong with trying to earn, though the required and available means, the things we want to achieve? If a prospective student knows that he needs so many hours of social work, he should avoid doing it unless he would have done it without needing it?

Can we really be certain that a student who fills his required quota of "good deeds" would not have done so otherwise? And for that matter - why are physicians held to these standards? Do we expect the same levels of altruism from ourselves?

Any promising young student who has done his research, and still wishes to enter medical school today, will be doing so knowing that he could well be buying his way onto a sinking ship. All of the litigation ... the distrust of physicians ... the governmental stumbling blocks ... etc. ... aren't conducive to the acquisition of great wealth and fame, and in fact seem to be indicative of quite the opposite.

To answer the original question, I'd like to see the medical schools put more emphasis on admitting students who are good, patient listeners ... compassionate ... they should have a prominent streak of humility.

I've known some doctors who were supposed to be excellent physicians, but they never seemed to "connect" with their patients. I think they were probably lacking in the qualities I mentioned.

However, medicine was not the worse because of them ... they simply did whatever it is they do, and they did it well.

 
At Sunday, August 27, 2006 12:51:00 PM, Anonymous Jaine said...

I’m sure my views sound very harsh and unfair. However, they are based on experience. The example of a pre-med student volunteering simply because he needed X number of volunteer hours is based on a stated fact by the pre-med. student. It doesn’t mean he won’t be a good doctor as he certainly was a good tutor. I was responding to the question of the qualities looked for in the admission interview and whether asking for certain qualities accomplishes the goal intended.

I don’t expect doctors to be altruistic. I expect them to know their area and to be ethical. Moof my concern is this. If the medical profession screens for the qualities you list ( good listening skills, compassion, and humility) yet in fact has a hidden curriculum that teaches the opposite what point was there in screening for those qualities?

 
At Wednesday, September 20, 2006 2:16:00 PM, Anonymous Anonymous said...

It is very unfortunate that Jaine had this experience with the pre-med student who tutored her child. It seems that from this experience she has come to the general belief that all pre-meds are like this. Jaine, did this young man actually get accepted to a medical school?

I will be the first to admit that the medical school admissions process is not a perfect one. Yes, it is very easy to simply stockpile the required activities, gather the required letters, and give the answers that you know the admissions committee wants to hear. With that said, surely you are aware that each year thousands upon thousands of students are rejected from medical schools, and only a very small percentage of the students who have theoretically done all of the above things actually get in.

Now, why these students and not the others? Surely their letters are all glowing, and their activities were all humanitarian and selfless. As a medical student myself, I would like to think that what set myself and my classmates apart from the others was our genuine desire to complete those activities and a real passion for helping people. I truly believe that many of the activities I added to my resume were done purely for the enjoyment of being of use in other people's lives. The fact that I put them on my resume was so that I could enter medical school and thereby be offered the privilege to spend the rest of my life being of use in other people's lives.

I also want to be very clear that medical school curriculum does not teach us to feel superior to our patients. I cannot speak for all students everywhere but I feel that my training has emphasized empathy, cultural understanding, and tolerance, and how to be the best doctor that you possibly can. Not one of my instructors has told me that I can look down on my patients or disrespect them, and we haven't had any classes on how to be rich and flaunt our wealth. It makes me very sad that people might think that. Do people realize that most physicians are actually in debt until their forties? Do people understand that we live in a time where malpractice insurance costs more than a mortgage, and the likelihood of being sued comes out to at least once per lifetime per physician? Medicine really isn't as incredibly cushy and lucrative as it may seem.

Perhaps it's just because I want to justify my own reasons for going into medicine...but I just don't think it's fair to say that we are all in it for the money.

 
At Wednesday, February 23, 2011 7:12:00 AM, Anonymous Anonymous said...

Hi. I am an anesthesiologist, 28 years into practice. Before medical school, I volunteered to clean up a flooded city to appear humanitarian, worked in a home for the disabled to appear caring, and worked cleaning up after lab rats to obtain a letter of recommendation. Through these experiences, I realized that I actually enjoyed the experiences and did care about the people and the animals I helped. It is a challenge not to become arrogant, but can be done. One must continue to work on oneself to keep compassion and happiness alive. I have seen many bitter physicians. It's all how you look at the world.I agree that the culture of the society, its emphasis on individuality and/or interconnectedness has a large influence on the type of doctor created. DoctorBeing

 

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