MEDICINE

Ive always wanted to be a doctor so I could make a difference. I felt that, by being a doctor, I would be able to make certain changesI could reverse the trend towards psychopharmacy and perhaps encourage psychotherapy. I could open up a little clinic and work with young people who were experiencing mental illness. I could change themed school curriculum, I could promote self-care in medical students, I could create a more supportive environment. But, most of all, I wanted to be able to use my experiences to change the way we practice medicine. For me, medicine means the opportunity to change the world. This idea was not received well by my ethics tutor. The system doesnt need improving, he said. Personal experience, experience outside of med school, has no place in the practice of medicine. Doctors arent doctors to create change. I disagree. It doesnt matter what profession youre in, whether it be nursing or teaching or government. We have the capacity to take our role and society and use it to make the world a better place. Every responsibility we take on has the potential to be used to make a difference. Our experiences, good and bad, can motivate us.

AlexandraCharrow:Implicit in what youre asking is the question of whether doctors are special, so special that we should be required to work additional hours and so integral to society that we have additional duties. For the 60 or so years that physicians have been able to actually cure people there has been an increasing fetishization of the field. Numerous TV shows and movies romanticize the occupation, feeding into a belief that medicine is the grandest and noblest of professions. Medicine is not the only profession with the power and duty to save lives air traffic controllers save lives every day. Yet how many shows are there about air traffic controllers? We are not alone in our unwavering responsibility, our duties, and our power. DerekMazique: The complexity of medicine, the physician shortage, and the rise of managed care almost guarantee

that physicians are no longer the only decision-makers in the room. So now, I think physicians are decidedly less special. Are they skilled and necessary for the average consumer? Yes, but so is their accountant. OfoleMgbako:Through my experiences with people living with HIV, I realized that the way people readily share the most intimate details of their lives and entrust their bodies with physicians is unlike any other profession. Each interaction with a patient is based on an unspoken covenant, a belief that the doctor not only will do no harm, but also will try to relieve suffering. I believe this basic, universal interaction between patient and physician engenders a greater responsibility on the part of physicians. It is difficult to speak to how much this dynamic sets us apart from the teachers, the lawyers, the scientists, the politicians. However, this dynamic does set us apart to some degree. Regardless of how much more exceptional doctors may be indeed, Siberts original argument was that doctors not only play a special role in society, but also that there are necessarily too few of them to justify any of us choosing to be a part-time doctor our student moderator, Gina Siddiqui, concluded that forcing physicians to work longer isnt necessarily the right answer. I dont know if its feeling special or a strong sense of duty or what, but on balance, I think most doctors will choose to work more, and coercing more hours out of those that dont is unlikely to do much good for patients, Siddiqui says. For the record, I think everyone should think his or her job is special, just like every mom should think her kid is special. Given the students debate, I wondered further whether

their views on the exceptionalism of doctors and on the importance of work-life balance were affecting their choice of specialty, particularly in light of the deepening primary care physician shortage. I asked them: Do salary and lifestyle play a role? Their responses: D.M.: Both my parents are in primary care, and seeing them practice has been a powerful example of how the field has changed. Perhaps most telling for me is how the current primary care situation is a perfect storm of low reimbursement and doctor burnout. Both of my parents have had to increase the number of patients they see for my mother who is in private practice, thats the only way she can keep the lights on. I didnt go into medicine in order to emerge as a strictly lifestyle physician but I did go into medicine expecting to forge meaningful relationships with my patients and to perform my intellectual craft to the utmost. Primary care in its current iteration makes these goals seem even more difficult. Of course, money is a factor, but these expectations of a personally fulfilling medical career also steer my decisionmaking process. A.C.: Personally, I recognize the pressure and fear that either my family values or career choices will have to change. I often meet physicians who tell me its possible to have both a family and a career, but for the most part, they are men with wives who have made the tough decision to work part-time for them. The women I have met have painted a more pragmatic picture you can have what you want, just not all of it. D.M.: All of us have been fixated on the profession, the role

of lifestyle when picking a specialty, and our own particular experiences as medical students. But at the end of the day, our concern for the patient should be paramount, and its also worth exploring the effects that these choices will have on them. If a surgeon spends less time in the operating room, will he or she show a greater error rate and will more patients be harmed? If doctors work shorter shifts and hand off patients more, will discontinuity of care lead to a spike in adverse drug events and complications?

Read more: http://healthland.time.com/2011/11/15/candoctors-have-work-life-balance-medical-studentsdiscuss/#ixzz2aocdxNXK