American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, January 13, 2015

How and why I became a doctor

Once in a great while, a patient asks me why I became a doctor. It surprises me that I am asked that question as infrequently as I am. Perhaps the average person assumes that doctors are born and not made, and that most of us “always wanted to be a doctor when we grew up”. I don't know about my colleagues, but I certainly didn't to start out with; neither to be a doctor nor to grow up. I'm still just wrapping my head around both.

The ingredients in making a doctor vary from individual and individual and even the same ingredients are mixed in varying degrees. The first assumption some people make is that doctors are motivated by a compassion to help our fellow human beings, while other more cynical patients assume we all went into it for the money. These are 2 ends of the spectrum, but few of us fall close to 1 side or another. And while there is probably a bell curve along this axis, there are many other axes. For example, it would be hard to find a pathologist whose lifelong dream to help others was by looking at microscope slides all day. Intellectual stimulation, curiosity, and the satisfaction of accomplishment all play a role. And while there are certainly a few doctors I know who calculated how they could make the highest income and chose medicine as the means, the majority of us had more complex and for the most part commendable reasons.

The first clue to an observer that I might have had “doctor potential” was my brains. (No, I won't assume a false modesty. ) This was apparent to family and friends even before I entered preschool. I was a precocious child and worked out how to do sums and multiplications up to past 100 even by the age of 3. My aunt, a teacher, enjoyed posing problems and I was delighted that I could solve them. This ability to come up with answers grew so that by the time I was in first grade, I was finishing class quizzes before my classmates had barely begun. At 1 point, my overtaxed teacher allowed me to help my classmates during quiz sessions. I distinctly remember one day a line formed at my “help” desk. I got a charge out of that because it made me feel important, respected, and in some measure, helpful.

The next ingredient in my career choice was a developing need to “fix” things. At an emotional level, I suspect the foundation was a wish to fix my own nuclear family. Mind you, I did not come from a broken home; far from it by conventional measures. But there was always a neediness in my parents' relationship that was worsened when my younger sister was born with what were at the time called some “adjustment problems” as a child. This worsened the family dynamic and even by the age of 12 I had a sense of deficiency in my parenting. I was even pressed by my parents into the role of emotional caregiver by the time I was a young teenager, although that brief period ended with the advent of teenage rebellion. I think this background may have contributed to my perennial urge to “fix” everything, whether it be a door that sticks, a workflow process that doesn't (work), or a shoulder joint that sticks. My wife keeps reminding me that it is not my role in life nor is it even my business to fix everything that seems to be functioning to less than what I think it should. But in a larger and more positive sense, the need to “repair the world” is one of the tenets of my religious (insert “lack of” here to be honest) faith. “Tikkun olam” is the Jewish phrase for repairing the world.

So far however, even by age 12, I regarded the medical profession only as a bunch of authority figures with needles. My interests were more technical. An inspiring science teacher saw my budding interest in electricity, which I was convinced was nothing less than magic. He lent me a box of telephone equipment and I was soon setting up an intercom for my parents to call me down for dinner. I took up an interest in modeling and found I enjoyed working with my hands. Soon this evolved into an interest in amateur radio, and before long I was building ham radios and studying for a license. At that point, the design and construction of radios so fascinated me that I set my sights on electrical engineering as a career. By high school I was even allowed to play with a new invention: a computer. In those days it was a matter of programming IBM cards in BASIC. But it was a chance to solve technical problems.

Meanwhile, a humanistic side was blossoming in direct parallel with the technical. I took an interest in writing. I wrote for and then edited the school paper. Then the yearbook. Then I started writing short stories and poetry. Stories mainly about people. I found that even on my Ham Radio, my main interest was in the other people I met on the air and not on the number of countries I collected or the construction of ever more complex radios. I changed my mind about career. I decided I was going to be a writer. I became a member of the high school literati.

It was at that point in high school that one of those—I hate to use the word epiphany—shall we say, formative moments occurred. You see, I had a crush on a classmate. It was not mutual, but we hung out in the same crowd. One warm spring day, we were seated on the expansive lawn of her sprawling colonial house when her father, a doctor, pulled into the driveway. The family Scottie dog came running, my friend ran to greet her Dad, and her Mom came out from the kitchen to greet him with a fresh-baked apple pie in her hands. This last part I think I embellished in my memory. I stayed for dinner and was treated to a tableau of what can only be described as a Norman Rockwell family, with Dad, the doctor, as the center of it all. I concluded 2 things from the experience: doctors make a good living and have adoring, happy families. Writers, I was coming to realize, live alone in garrets and eke out a living word by word. Maybe I could learn to be a doctor and write on the side.

By the time college loomed, I began brooding about the meaning of life. Somewhere, the quixotic notion of founding all ethics and science on a solid ground of a priori logic and factual construct entered my head. I started spending my study hall hours in the library reading all I could about philosophy. I went off to college and promptly signed up for a major in philosophy . But I was immediately asked by parents, relatives and friends how I proposed to make a living as a philosopher. Easy, I decided! Doctors make a lot of money, right? So why not be a doctor part time and philosophize in my leisure? I finally had an answer for the skeptics: I was going to be a meta-physician. Get it?

It was only at that point that I gradually took an interest in what medicine actually entailed. But what I learned was inspiring. First, I read a tell-all book entitled ”Intern!” by Dr. X, which chronicled the first year of a doctor in training who had spent some time at Johns Hopkins, wherever that was. What adventure! Life and death! Saving lives! Now that's what I call the meaning of life! By the time I was a college senior, I was had applied and was admitted to—guess where—Johns Hopkins Medical School. I waited for graduation day and studied works of medical history such as Cushing's ”Life of Osler.” I found all kinds of medical historical reading to occupy the time that I was studiously devoting to not studying

I entered medical school in September 1974 and found it was a major adjustment after a life of liberal education. But that's a tale for another post. By that time, even before donning a white coat, I was already becoming a doctor.

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
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.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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