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Career and Culture: A Med Student’s View

jonah zuflacht

By Jonah P. Zuflacht

If applying to medical school involves convincing others why you wish to become a doctor, medical school itself initiates the process of determining what kind of doctor you will become. For the most part, our nation’s future physicians make the transition with at least some vague notions in mind: “I’m interested in surgery” or “Working with kids has always appealed to me.” Others, meanwhile, have more specific aspirations: “Pediatric cardiology with a focus on Marfan syndrome” or “Interventional neuroradiology at an academic medical center.”

Almost immediately after donning the white coat, these attitudes begin to change. Priorities are reshuffled. Hidden skills are developed. Career goals evolve. The future breast surgeon realizes that the scalpel is no longer quite as appealing. The hopeful E.R. doc is unexpectedly drawn to the detective work of endocrinology. For those who haven’t any clue, we are told not to worry. “You’ll find your fit. It’s about how well you click. It’s about culture.”

From our earliest interactions with residents, fellows, and attendings, these unique, specialty-specific cultures become readily apparent. Personality stereotypes, for instance, are well established: jocks go in to orthopedics, nerds do internal medicine, super-nerds, neurology. Outdoorsy types go in to emergency medicine, while family medicine attracts the single-payer-hopeful hippies.

Undoubtedly oversimplified, if not entirely false, the accuracy of these stereotypes is not at question here. It is, however, important to point out that they do exist and that many medical students identify with a given specialty based, to some extent, on these stereotypes. Intellectual stimulation, be it the mechanics of heart disease or the chemistry of renal physiology, is another factor. Lifestyle, and the length of training required to realize that lifestyle, must both be considered. Those interested in ear, nose, and throat (ENT), for example, can expect early nights and tennis. And however difficult it is to admit, future earning potential – especially when most of us will graduate with seemingly insurmountable medical school debt – is certainly something to think about. With this framework in place, we slowly gravitate towards a specialty, and culture, that fits.

Discussions of this sort are commonplace at the medical school dinner table. In contemplating the merits of psychiatry, one classmate recently explained that he was interested in psychiatry because it is the only specialty in which you get to sit down and actually talk with your patient. “No other field affords you the time to actually listen,” he noted. I took his comment at face value without processing what he had said. It wasn’t until much later that I revisited the issue. Should the physician’s ability to have an unhurried conversation with his or her patient be limited to psychiatry? Isn’t this the basic foundation of every doctor-patient relationship? I explored this very theme in my medical school application essay when writing about why I wanted to become a doctor, and I foolishly ignored it when discussing what kind of doctor I wanted to become.

Deciding on a specialty represents a significant step in defining our sense of professional identity, but it is only one piece of the puzzle. I would submit that the most important cultural elements transcend the traditional silos of medical and surgical specialties. They are not unique to pediatrics or dermatology, but rather a common thread among all forms of care – key ingredients in the art of healing. This is a culture of compassion and of understanding. Of approachability. Of spending time with your patient, and their family. Of cultivating a meaningful relationship built upon trust. Of hearing your patient’s concerns and abiding by their wishes. To paraphrase Osler, of treating them as a person rather than a vessel of disease.

Unfortunately, we – even as medical students – are beholden to the system in which we operate. And despite our best intentions, our capacity to uphold these basic tenets of patient care is often severely limited. We are limited by time constraints. By the hierarchy that writes our recommendations. By the bureaucracy of paperwork and EMRs. By insurance policies. By the medical-industrial complex we naively thought was focused on the patient and not on the bottom line. What about those altruistic intentions that brought us in to medicine in the first place? Must we forfeit our commitment to patient-centeredness in order to become a modern-day doctor? Must we abandon our eagerness to spend time talking with the patient in order to economically treat their illness? Must we sacrifice one set of cultural values for another? I sincerely hope not.

According to Dr. Bernard Lown, cardiologist and humanist, Nobelist and teacher, rediscovering the fundamental relationship between doctor and patient is the antidote to the crisis plaguing our medical system. This summer, interning at his namesake organization, the Lown Institute, has helped me broaden my conception of the doctor I wish to become and allowed me to better define what sort of medical culture I wish to become a part of. In discussions with like-minded practitioners across the country, among all specialties, it is clear that the seeds of meaningful, cultural change have already been sown. I could not be more excited to join them. Uniting and guiding this movement forward: Remembering why we chose medicine to begin with.

Jonah P. Zuflacht is a second year medical student in the Columbia-Bassett Program at the Columbia University College of Physicians & Surgeons – an innovative program built upon longitudinal clinical clerkships and healthcare systems improvement. He grew up in Lenox, Mass. and graduated cum laude from Williams College in 2011 with a major in Biology. After college, he moved to Boston, where he worked as a Clinical Research Assistant in the Department of Cardiovascular Medicine at Brigham and Women’s Hospital, conducting clinical research trials in patients with vascular disease.

Jonah is proud to continue his family’s medical tradition as a third-generation physician, committed to restoring humanism to medicine. His other interests include healthcare quality improvement and innovative care-delivery models.