One day in anatomy lab, somewhere between sawing through ribs and intercostal muscles, my group started talking about what kind of doctors we wanted to be. One of them said that he didn’t want to see patients: he wanted to be a hospital executive and run a hospital chain.
What he said shocked me at first. I went straight through high school, college, and started medical school never thinking that I would do anything but see patients in the clinic or the hospital, and teach medical students in the process. Without patients, we as doctors were nothing. Or so I thought.
Do doctors need to see patients to be “real doctors?” This is such a fundamental question that in 2011, the Australian Medical Association took it upon themselves to define “the role of a doctor.” They reiterated the basic tenets of medical professionalism, but also stated:
In many cases, because of their continuity in post and their subsequent deep understanding of the needs of the local community, their hospital and their patients, doctors offer the necessary knowledge and continuity required to improve services and the care of patients. Their role of advocacy for patients, communities and particularly for patients and communities who may be disenfranchised or powerless, is vital in contributing to improving health and well-being outcomes.
This assumes that if a doctor does not take on individual patients, they instead take on a social justice role in advocating for patients.
The AAMC All Schools Graduation Questionnaire shows that in 2014, 2.7% of US medical students did not plan to seek a specialty, and another 7.3% were “unsure.” (47.5% were unsure if they would seek fellowship training after residency.) This means that each year, a small, but not insignificant, number of newly-minted doctors choose to do something other than clinical care. Clearly, they wanted to do something else than see patients individually (or for the pathologists and radiologists out there, deal with individual clinical cases).
During my training, I have encountered people with MD’s who have:
- written best-selling novels, memoirs, poetry, and non-fiction about health and medicine (or something completely different)
- started tech companies that service hospitals and clinics
- gone to business school to become CEOs
- signed up to work for pharmaceutical companies
- worked for insurance companies to verify claims
- eschewed patients or seen them 5-10% of their working time, spending the rest on research or academic duties
- worked in the media (TV) in educational–or not so educational–roles
- consulted for these TV shows
- developed product lines (looking at you, dermatologists)
- started NGOs that provide healthcare to developing countries
- continued their military careers while working as doctors
- worked as advisors for the federal government or politicians
- have become politicians
- consulted for firms like Boston Consulting Group
- produced art based on medicine (or something completely different)
Although I was skeptical of my friend’s intentions at first, as time went on, I saw how fulfilling it could be to serve a purpose beyond the clinic. As someone who loves writing, and teaching, and many other things, I have often felt pulled in different directions to do something “more than medicine:” to use my training and skills to serve whole populations, in addition to individual patients.
So, what do you think? Do we need doctors to care for more individual patients, or doctors who do mostly non-clinical activities? Do YOU have a call to “more than medicine,” and if so, what is it?