Chapter 6 Perfect Phrases for Showing Thoughtfulness about Medicine
"In your opinion, what contemporary medical issue needs to be addressed in the U.S. healthcare system and why?"
(State University of New York, Stony Brook)
"What do you see as the most significant issue the medical profession will face in the next forty years?"
(University of Connecticut)
Earning double-digit MCAT scores and high grades in premed classes are two excellent ways to show that you have what it takes to go into medicine. But another is to show that you've thought seriously and deeply about the problems that confront the profession you claim to want to join. Application essays in which you thoughtfully analyze a medical issue or show you understand medicine's "bigger picture" can set you apart from the thousands of other applicants who focus only on their clinical experiences and burning desire to help others. Here are some perfect phrases illustrating applicants' thoughtfulness about medicine.
The experience in hospital finance I gained at Medical College of Wisconsin afforded me a behind-the-scenes look at the business side of medicine. Counseling patients and families on the costs of their proposed treatments drove home for me the human impact of medicine's high costs. Some patients were denied care, while others were forced to take on unimaginable debt. As I worked to improve collection rates, cut costs, and optimize patient billing, I saw how revenue pressures are forcing health care's practitioners to demand that more patients be scheduled at the same time that clinic expenses are cut further.
My research on income inequality at the National Poverty Research Council proved beyond all doubt to me that increasing medical access for the uninsured has implications far beyond just preventing illness. It reduces income inequality and economic dependency by increasing individuals' capacity for work and thus their ability to improve their situation. In a very real sense, by becoming a physician and providing medical care to the uninsured, I will be able to help my patients break the poverty cycle by giving them the health they need to pursue education and better careers.
Today, I consult at Phoenix-area medical centers. As part of a team of consultants for SunCare, I worry that the federal government's Medicare Ambulatory Payment Classification System will adversely affect our hospitals' already precarious finances. Instead of interviewing mothers, I interview charge nurses, attending physicians, registration clerks, and department managers to target opportunities for missed reimbursements. Based on our quantitative analyses, we issue recommendations to improve department-specific accuracy, hospitalwide efficiency, and federal regulatory compliance. But how can analyzing Medicare reimbursements address the even greater public health issues that our nation faces?
My ambition to help people by practicing medicine was reaffirmed when I participated in the Tulane pain rounds last fall. The weekly rounds at New Orleans General Hospital were attended by a group of physicians, surgeons, psychologists, physical therapists, and researchers who collaborated to examine the most enigmatic of pain cases. Although there were rarely simple solutions for these debilitated patients, I learned that a multidisciplinary approach to pain management can provide insights that would otherwise be unavailable to each specialization individually. My participation in the pain rounds opened my eyes to the complexities of clinical decision making. With this firsthand exposure to the hospital setting and the expertise of medical professionals, my decision to pursue a medical career was sealed.
Last year I was a tutor for Kansas City People Advocates, whose sponsoring company, a neighborhood development corporation, offers subsidized health care to low-income families. I was stunned to discover that the subsidized health care this corporation offers goes sorely underutilized. In conversations with parents I learned that cultural biases—including a belief in showing silent strength in the face of hardship—often restrain Hispanic mothers from seeking preventive health care for their kids. Clearly, providing low-cost insurance and accessible, multilingual health clinics for immigrant children is only part of an effective health-care solution. Equally important is ensuring that the health-care clinics and local health programs meet a high quality standard that encourages people to walk through clinic doors, while still respecting their cultural views about health care. Finally, my tutoring in Kansas City's Hispanic community has also taught me that low academic performance can be directly attributable to students' health. Colds, flus, and even tuberculosis go unchecked by hardworking immigrant parents who work long hours and who, because of language barriers and low education levels, are unaware of the importance of regular doctors' visits.
"There is a body of knowledge peculiar to the medical problems and needs of military units, and that knowledge base is different from that required in ordinary medical practice." As a youngster watching war movies made painfully real by the vivid commentary of my late uncle, a World War II veteran, I knew that military medicine was, in Dr. James Zimble's words, "different" from conventional medicine, especially in combat casualty care. It was in a college philosophy course, "Morality and War," at Auburn University, however, that I first began to seriously grapple with the issues peculiar to military medicine. In discussing the notions of morality and justice in the context of combat, Professor Ian Powys forced us to compare the unsentimentally pragmatic ethics of the soldier and medic in battle to the more abstract and less urgent morality of civilian practitioners. Clearly, the military physician is sometimes torn between his or her duty to the Hippocratic oath and duty to the military in such areas as patient privacy, the ethics of withholding treatment to extract information from a POW, and determining what behavior is "moral" in combat situations. I am drawn to a military medical career because the ethical issues unique to it will only grow as the U.S. military faces such emerging challenges as coping with extended worldwide deployments, its growing humanitarian role during natural disasters, and the steadily increasing population of military retirees.
My intellectual interest is Buddhist psychology, which I believe can be linked to medicine. Buddhism's goal is to end suffering for all through the Four Noble Truths, which essentially teach individuals to live a life that benefits everyone in such a way that any individual can be happy without possessing anything. Though in our materialistic society this is obviously a difficult ideal to live up to, I believe we can each work to end suffering in our own individual ways. As I took courses in Buddhism and premed subjects at Cornell, I began to see that as a physician I could work to alleviate patients' mental suffering just as much as their physical pain. As a volunteer with the Health Staff Assistant Program and the Ithaca Cardiac Clinic, I saw that, quite aside from their medical skills, the attitude, philosophy, and manner that doctors bring to bear on each patient can create a positive and tangible effect in patients that can reduce suffering and save lives.
I believe that it is as a physician that I can best address the urgent health-care issues the United States faces today. Take home hospice care. Today, the Delaware Hospice of Dover serves more people each year than any other in the mid-Atlantic states, and most of Kent County's foreseeable deaths are serviced by the hospice. This is a direct result of the determined fund-raising efforts of the hospice's administration, many of its volunteers, and residents of Dover, but also of the effective education that the hospice gives its volunteers, who often have no idea what a hospice does before enrolling in the program. Last August, after learning about the Delaware Hospice, I began volunteering weekly in its clinic. The patients I have helped have genuinely benefited because of the emotional reassurance and controlled pain management I provide. This is the kind of medicine that attracts me–efficient systems that serve diverse people's needs and operate effectively while staying close to their communities.
As a child growing up in Bosnia, my life was harshly interrupted by the devastating Yugoslav wars of the 1990s. The bombing of cities, including my own, Citluk, was a frequent occurrence. My older brother, Andro, and I served as volunteer EMTs for three years, and together we witnessed the horrors of war and genocide. By the time I was only 16, the sight of blood and death had quite ceased to shock me. After each explosion, the survivors, including myself, would routinely head out into the streets and alleys to methodically pull the victims out of their shattered homes. Because there weren't enough (and in some instances, any) medical emergency vehicles, we loaded many victims onto the back of dusty pickup trucks for the trip to the local hospitals, whose primitive sterilization techniques sometimes cost victims their lives. All around me I saw dramatic evidence of what medical attention—of even the most rudimentary kind—can mean to people in need.
When I was traveling through the Philippines, I observed a shocking reality that contradicted my parents' romanticized picture of my "homeland." Almost everywhere I traveled, I saw rural youth addicted to opium. In village after village, I saw the same blank stares and bulging eyes. Despite a massive influx of opium from Thailand and Laos, government officials paid only lip service to curbing opium trafficking at best and at worst actively supplied the drug, especially during election time. Though I had planned to stay in Manila only six weeks, I remained over a year. Armed with a few papers from the Internet, a Physician Assistant's Drug Handbook, and Peiser and Sandry's The Universal 12-Step Program, I set out with the modest ambition of changing the world. Sleeping with rodent-sized insects, showering with wild toads, and digging holes in the hard ground for toilets were not what made these months so challenging. It was the sheer magnitude of the Philippines' drug problem. In Manila, unlike the United States, drug addiction is seen as a moral vice rather than an illness. Rehabilitation facilities are scarce, and few families wish to acknowledge the problem for fear of public shame. Despite these daunting obstacles and my at best shaky command of Tagalog, I felt for the first time in my life that I had a calling.
I have spent hundreds of hours volunteering in clinical health-care settings—Johns Hopkins Hospital and Chestertown Health Center and, since 2008, Nashville Municipal Hospital's emergency room. Today, I transport patients, deliver lab specimens, clean and prepare patient rooms, and talk with patients to make them feel comfortable—all in the same environment that was so intimidating to me as an eight-year-old. I have seen residents literally work entire days without taking a break to eat. I have seen on-call physicians forced to leave weddings to come to the ER, or in some cases left with no choice but to drag their children to the hospital with them. And beyond these personal sacrifices, I have also seen the unfortunate truth that doctors cannot always honestly reassure patients and their loved ones that everything will be all right. For example, my uncle Roy, ravaged by tongue cancer, was initially treated with chemotherapy, but it eventually failed. His doctors then surgically removed his larynx, but the cancer still spread. Losing him after an eight-year battle will always be a grim personal reminder of the limits of modern medicine. And yet nothing of what I've witnessed has diminished the awe I still feel at doctors' power to save lives and comfort patients.
The anxious hospital scene before me aroused the same sense of injustice I had felt only a year before when California passed the anti-immigrant Proposition 187 and over a million people—400,000 kids—were suddenly denied basic medical care. As a high school student, I had helped organize a student protest at UC San Diego, collecting over 500 signatures to overturn the new law. As the daughter of two immigrants, I was raised to revere the ideals of equality and opportunity, so when I began to define what "equality" meant to me, I saw health care as a fundamental component. Everyone deserves a fair shot at a healthy, productive life.
Evaluating my health-related involvements on a social scale—by the extent to which I have been able to provide care directly to those who most need it—has accelerated my personal route to the profession of medicine. As a physician in a large, urban hospital, I might be able to safeguard Angel's T-cell count. I could immunize disenfranchised children and increase their access to health care. I could incorporate my understanding of the emotional consequences of HIV infection with concrete, clinical knowledge. And I could lead fellow physicians, with my growing understanding of methods for improving hospital efficiency, in efforts to reform health policy. I am eager to do all this, yet I realize that medicine will still ask even more profound questions of me: Can the necessary efficiencies that a market-driven health-care system provides exist in a more publicly managed, universal health-care system? Can I reconcile my idealism with the reality of health-care finances today?
I concur with Carl Elliot's observation that medicine's greatest philosophical problems are not caused by institutional or technological developments but by perplexities arising from the very nature and ends of medicine. For example, although the physicians at United Care found our health assessment tool to be a useful initial intake health screen, they did not accept it as the gold standard for comprehensive care as we had hoped. I believe physician and bioethicist John Lantos has explained why we failed: medicine cannot effectively evaluate itself because it cannot agree on what the criteria for that self-evaluation should be.
The three weeks I spent as my ailing grandmother's nurse aide in a Pakistani hospital will stay with me until I die. Pakistan's chronic shortage of medical staff and funding shifts the burden for providing care squarely onto the family, even when a patient has been hospitalized. Although I took on this responsibility gladly for my grandmother, I was saddened by Rawalpindi City Hospital's old, poorly maintained facility and equipment, the appalling ratio of patients to staff, and the doctors' complete eschewal of anything like a "bedside manner." In many cases, doctors were downright rude to patients. Even simple hygiene such as hand-washing was dispensed with. In those few weeks, my determination to become the kind of doctor who could help patients like my grandmother grew in intensity and focus.
Learning, dedication, and compassion are the tools of physicians and teachers alike. As an intern at Ohio University Medical Center and at Boone Clinic in Cincinnati, I watched as doctors used all three of these skills to help patients maintain good mental, physical, and spiritual health. If patients were healthy, they taught them how to stay that way. If patients were ill, they taught them how to become better. I remember watching a grin grow across a father's face as Dr. Hume taught him about nerves and how they slowly grow back after certain injuries. The man was relieved to learn that his daughter would soon regain feeling in her fingers. It is this principle element of a doctor's job—healing through teaching—that is perhaps the primary reason I am so strongly driven to a career in medicine.