Blog | Wednesday, June 13, 2012

Does a service history predict physician behavior?

What follows is meant to be highly provocative. I have used some hyperbole. I hope some readers will agree and some readers will consider this screed inane and dumb. Please comment and criticize my hypotheses. If this makes you think critically, then I have succeeded.

Highly valuing service behavior has become a major plus in choosing medical students. This fashion has great face validity, but we should always ask tough questions about any new fad.

Yesterday on Twitter I saw this wonderful quote: "The more logical a solution to a complex problem sounds, the more strongly it deserves to be challenged." Ackoff

Of course pre-med students now pad their resumes with service work, checking off another box.

The idea that service predicts seems a bit too simple. Do we necessarily want our physicians to all value service? A wonderful New York Times column should make one think – The Service Patch

I am not against "service," but I will take the position that admissions committees overvalue the concept. I think David Brooks would agree:

"The student discussion was smart, civil and illuminating. But I was struck by the unspoken assumptions. Many of these students seem to have a blinkered view of their options. There's crass but affluent investment banking. There's the poor but noble nonprofit world. And then there is the world of high-tech start-ups, which magically provides money and coolness simultaneously. But there was little interest in or awareness of the ministry, the military, the academy, government service or the zillion other sectors.

"Furthermore, few students showed any interest in working for a company that actually makes products. It sometimes seems that good students at schools in blue states go into service capitalism (consulting and finance) while good students in red states go into production capitalism (Procter & Gamble, John Deere, AutoZone).

"The discussion also reinforced a thought I've had in many other contexts: that community service has become a patch for morality. Many people today have not been given vocabularies to talk about what virtue is, what character consists of, and in which way excellence lies, so they just talk about community service, figuring that if you are doing the sort of work that Bono celebrates then you must be a good person.

"Let's put it differently. Many people today find it easy to use the vocabulary of entrepreneurialism, whether they are in business or social entrepreneurs. This is a utilitarian vocabulary. How can I serve the greatest number? How can I most productively apply my talents to the problems of the world? It's about resource allocation.

"People are less good at using the vocabulary of moral evaluation, which is less about what sort of career path you choose than what sort of person you are.

"In whatever field you go into, you will face greed, frustration and failure. You may find your life challenged by depression, alcoholism, infidelity, your own stupidity and self-indulgence. So how should you structure your soul to prepare for this? Simply working at Amnesty International instead of McKinsey is not necessarily going to help you with these primal character tests."

We should not assume that doing service predicts anything. Using a service history as a proxy for character fails the smell test. Pre-med students are smart, and they can figure out what they need to do and say to bolster their applications.

We should not over value service. Rather we should provide medical school environments that provide appropriate role models.

Many medical students enter school for the "right reasons", and somehow we change them. We change them with exorbitant tuitions, too many teachers who would rather be doing research or caring for patients, and too few role models. We have a testing system that, in my opinion, rewards test taking and memorization. We test for knowledge but we need physicians who have wisdom. Not all physicians have to be service-minded. Some great physicians believe that they provide "service" every day through compassionate care of their patients. For many that is enough.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.