So, You Want to Be a Doctor

And finally...

Myriad pathways lead to medical school. The funnel-like system ever narrowing a stream of applicants begins when a student attends a quality college. A degree in science helps, although one in the arts or humanities is regarded more favorably than it once was. Medical aptitude tests loom like thunderheads sweeping across southern Minnesota’s rolling plains. Unavoidable, terrifying. Perhaps the scion of an inter-generational medical family has a slight edge when it comes to college acceptance.

Stay hopeful, you who are female, who spring from farm, mine, reservation, small town or middle-class city, church-attending or agnostic America. I have known and worked with more of you than I have with those for whom medicine had been preordained.

Medicine has “a thousand mansions.” There is one prepared for the generous of heart who sees medicine as a commitment to service. There is one prepared for she who worships pure science, who rarely meets those who benefit from her work. There is one prepared for that pioneer so confident by nature that he does not shy from innovative surgery or treatments just beyond established borders. There is one prepared for the comforter who willingly attends to everyday afflictions. Of the young and very young. Of those at the far end of a life. Another is prepared for he who heals the crumpled psyche.

My doorway leading to medical school opened one afternoon in Iowa’s grubby Camp Dodge Army Induction Center. It was the fall of 1942. I was in my second year of college, and a fledgling Army recruit. A sergeant sat across his desk from me.

“Ever thought about going to medical school?” he growled.

(I later found out that sergeants regard growling as normal human interaction. Most of them. Congenial, soft-spoken medical-school classmate Sgt. Jerome Keefe was a glowing exception.)

“Medical school?” I said.

“We need doctors in the service. Your aptitude test scores suggest you might make it.”

“The, uh, alternative?”

“We also need infantrymen.”

“How do I get to be a doctor?”

He shrugged. “It would help if you were accepted by a qualified medical school in the next three months.”

Motivation is the spark plug to a life. My father happened to be dean of men in Minnesota’s Winona State Teachers College. After weighing the options for nearly ten minutes, I called him. He contacted Dr. Harold Diehl, then dean of the Minnesota Medical School, and I received application blanks within the week. I was accepted.

Where is medicine headed today? I see a forest of paradox. Science and technology burst ahead like the shock wave of an explosion. Yesterday’s science fiction is today’s power to heal. Yet, people in our country and around the world go without fundamental care. Immunizations. Medicines to abate epidemics. Clean water and adequate sewage disposal! Protection from insects that spread disease. How does the latest life-saving drug provide a cure when it hides on a pharmacist’s shelf, sequestered behind the barrier of an unaffordable price? Fewer can afford health insurance at the same time that politicians demand cuts in safety-net programs, this in the name of economy.

Does society worship so compulsively at the altar of money that we can see no way clear to the provision of adequate medical care for all?

Access to appropriate medical care is a right, not a privilege! In the same sense, our society demands, and pays for, other rights that are as fundamental. Safe, potable water from the kitchen tap. Disposal of sewage. Oversight of food supplies. Safety standards for public conveyances. Licensure of health professionals and others where public well-being is at stake. Protectors—firemen, police, military forces—are guaranteed by some unit of government, not left to a patchwork of profit-oriented insurance companies. I believe mandated universal health care to be a principle decades past its time. Indeed, more than one path leads to such a goal: a social “security”-like federal program, a patchwork of state programs, some compromise with (and a sufficient degree of control over) the insurance industry.

Does not the very word “insurance” denote certainty? Yet, jousting with one’s health insurer for coverage that has been promised is frequent. We Americans claim fealty to justice. If we may, call it compassion. I submit, in justice, that no honest citizen should be faced with having to choose between food and a vital medication. Would that this were the reality!

Sixty years ago, when I was beginning my practice, the bugaboo raised at the idea of universal health care was that it would be socialized medicine. I was still immersed in learning my craft, and political winds wailed in someone else’s backyard. I shrugged and echoed colleagues more attuned to politics. Years later, after watching the financial impact of my medical decisions on so many of my patients, I came to realize that the quality and availability of medical care based on the health of one’s bank account was wrong. Unjust!

Until a doctor acquires the infallibility of a robot, a computer, he and she will sometimes stumble. A patient may be injured. Doctors are warned by their own organizations and the companies that insure them never to admit a mistake. Common humanity and compassion fall victim to a fear of litigation that drives a physician and his patients apart. Students of law provide the very safeguards that define and ensure civilization. Physicians provide the safeguards against indifferent nature and disease. Are not most practitioners from these two professions honest, caring and compassionate? I accept the premise as a given, then am confounded by our mutual distrust. I have known doctors who refuse to treat attorneys “for fear of being sued.” I hear lawyers rail at doctors as being “conniving vultures,” interested only in a large income.

I challenge our two noble professions: Is there truly no way that a patient can be compensated for real injury, in a spirit of humility, trust and respect?

It is said that one can never return home, return to his roots, return to a simpler time of life. Perhaps not. Who would forego the benefits of scientific progress? When I talk to younger doctors these days, I often hear cynicism. Some look toward retirement while they are in the fruitful years of a career, as though the burden looming ahead is overpowering.

I hear discouragement from having to spar with insurance companies over medical issues, from coping with avalanches of paperwork. Some medical decisions seem designed more to protect the doctor from theoretical legal hazards than to meet a patient’s needs. Productivity is the catchword in many a clinic and HMO.

What did we old country doctors have that I sense is missing today? Long hours of work? True. Alone at times, faced with problems when skilled help would have been so welcome? Oh, yes.

What I understood during those decades in my beloved northwoods was that I was needed, that my neighbors and patients considered me a friend, that life was seldom boring. Anything that can happen to a person can send him or her to the office or emergency room of a country doctor.

Nostalgia can blunt the sharp edges of reality. Still, I choose to believe that we enjoyed special times during those years in the country. Are there candidates to replace us waiting in the wings? Physicians who understand that the very word means healer? Can the rigors of science wed with the compassions of that era, tinted golden by memory?

How about it, young colleagues?

THE END