Leaven #15

“What has happened to me?”

A young physician – whose parents were activists for human rights both in their native India and in the United States -- asked this painful question a few weeks before completing her residency training in a Tennessee program. She was responding to one of several selections I had highlighted while reviewing the personal statements she and her fellow residents had written for their residency applications four years earlier.

“I am passionate about the socio-economic issues that contribute to suffering. . . . Inspired by Albert Schweitzer and by organizations such as Doctors Without Borders, I chose to study medicine. . . . My path as a physician will lead me to work with the underserved in this country and abroad. . . . My goal is to establish sister clinics here and in the developing world and to provide longitudinal care in an integrative fashion.”

As she read those thoughtful, expectant, energetic intentions on the screen in a “What’s ahead?” discussion a colleague and I were facilitating for the program’s senior residents, she softly commented with a slight gasp, “I think I said something like that in my personal statement.” The selection did in fact come from her personal statement. Her focus, however, quickly moved inward. She began to speak – softly, honestly, tearfully – to herself . . . and to her peers.

“Now where am I? I dream of taking care of rich patients, educated patients, compliant patients, healthy patients. What has happened to me?”

What explanation does your experience suggest?

Perhaps her intentions had been altered as she searched for relief from chronic fatigue. Perhaps her intentions had been eroded by too many disheartening confrontations with the gatekeepers empowered by ‘the system’ to decide what medical services will (not) be approved/compensated. Perhaps her intentions had been effaced by the very patients for whom she had envisioned medicine could make a difference.

Her intent to promote a patient’s interests/values seemed to be in tact. Her intent to respect a patient’s informed choice seemed to be in tact. However, she had lost touch – permanently? -- with her social conscience . . . with the association she had seen for so many years between medicine and social justice.

What do you think is ahead for young physicians represented by this resident? Who/where are they five years after residency? What types of practices do they join? What do they consider a ‘good patient mix’?

Nurse or social worker or therapist or physician or . . . -- what passion, what inspiration, what goal brought you into medicine? For what do you dream now?

Think about it. Perhaps talk to a coworker.