The Swedish diplomat Dag Hammarskjöld is widely considered to be the epitomy of a global diplomat. He served as the second Secretary-General of the United Nations, but sadly died during his term in a plane crash in 1961. He is one of just three people to be posthumously awarded the Nobel Peace Prize. John F Kennedy called him “the greatest statesman of our century”. Considering the turbulence of the first half of the last century, that’s quite an accolade.
If you don’t know very much about Mr. Hammarskjöld, his life story makes fascinating reading. He was a man of great integrity who worked tirelessly on several peace projects after World War II. Many wise and thoughtful quotations are attributed to him, some of which are actually very relevant to medicine and health. One of them is about how “constant attention by a good nurse may be just as important as a major operation by a surgeon.” Few would disagree. Dag Hammarskjöld was a man who understood the nature of humans and the complexities of our world.
But back to medicine. The job of a physician is ultimately one that is about everyday human contact. It’s about as frontline as you can get. As our health care system changes rapidly, many doctors are increasingly moving their careers into new realms. These include fields such as health care administration, resource planning, quality improvement, and health care information technology—all very important areas where doctors can no doubt make a huge difference.
Those doctors who are exploring and progressing in these areas often find themselves facing a dilemma. They need to divide their time between clinical practice and their other career aims. The two can, and frequently do, conflict. I’m sad to say that I’ve seen many doctors open about their desire not to practice clinical medicine, and use such alternative career paths as a way to get away from seeing patients. That’s a terrific shame. I’ve found this happening particularly in health care IT (which also leads to the question why anyone who seriously enjoys sitting in front of computers more than meeting real people would have become a doctor in the first place!)
After so many years learning the fine art of medicine, doctors should always think twice about saying goodbye to clinical practice, not least because medicine is a practice that can easily be lost after just several months away from the frontlines. I’ve seen it happen to many people I know. It’s very difficult to return after walking away. Often they console themselves that they are working towards a “higher cause” in health care with their other career goals.
There is of course nothing wrong with a doctor, or any professional for that matter, wanting to explore ways to improve the systems that they are working in. By doing this, they can not only help one person at a time, but can actually in theory save a whole population. It seems like a great cause to be working towards when we are talking about improving a whole hospital or even an entire health care system.
Doctors can do this by working in a number of capacities—as administrators, for the government, or even for private companies—all geared towards advancing health care in some shape or form. But what about all those years of medical education and training? The labor of medical school, long lecture schedules, late night studying, the never-ending exams. Every doctor remembers those days of constant hard work just to be able to call themselves “doctor.”
In reality however, the two careers do not need to be mutually exclusive. The best health care administrators and planners that I’ve ever worked with have been the ones who manage to balance the two (often they’ve been the best doctors as well). It’s perfectly feasible and there are countless examples of such physicians all over the country. And we’re not talking about a day or 2 here or there of clinical medicine every month. Many doctors manage much more than this, so they actually still get a feel of real frontline medicine.
The worst possible option is to give up clinical practice completely when they expand their careers. Whether the aim is to progress within an institution or a separate entrepreneurial venture, doctors should keep being doctors. After all, it’s where they gained their knowledge and experience of health care in the first place. It’s also usually what they do best.
That’s my advice for any doctor faced with that dilemma right now. Being a doctor is a privilege and an honor. What about the patients that need you, the waiting families, the nurses with questions on how to make their patients feel better? It’s those one on one moments with patients and their families that make the job so special—the trust and special bond between doctor and patient is not reproducible in many other arenas, no matter how worthwhile the work may seem. In the midst of our busy and hectic days it is sometimes easy to forget the enormous responsibility that comes with being doctor. The job can seem never-ending and the to-do list can feel like the world on your shoulders. Often nothing short of super human effort is expected of you each and every day.
Back then to Dag Hammarskjöld. This particular piece of advice applies to any doctor wondering what is the most worthwhile thing to be doing. He said; “It is more noble to give yourself completely to one individual than to labor diligently for the salvation of the masses”. If there’s ever any question about what the higher cause is—striving to save the world or just being a good doctor—the answer is right there. It is always selflessly dedicating yourself to your patients.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.