Time to Move on...

I'm more or less set on going to Iowa next year, and the three following. The question is, where do I plan on going afterwards, for medical school? The University of Iowa has an excellent medical program, one of the top in the nation as a matter of fact. But there lies one problem in all of this: I don't know how long I can take it here in Iowa. I'm not from here, and while I've lived here for pretty much most of my life, I hold no loyalty to this place. In fact, ever since I came here I've been waiting to leave. Snow? Below zero temperatures? No Beach? No. This place really is not for me. Which is why I'm glad I picked the profession I did.

Wherever there are human beings, there are bound to be doctors. The job is not tied to a specific geographic location like say an oil driller or a corn planter might be. Likewise, it allows for easy permanent settlement. An established doctor in a community has arguably some of the best job security you can get. He is simply too invaluable to let go. It's such a blessing to be a doctor because of the sheer amount of options you are given at your fingertips. One of those options I would instantly pursue would be moving down somewhere south. If I was a doctor today, I would probably head somewhere like Atlanta or southern Florida. I'm a big city type, and it's no big secret that that region is a hot spot for retirees. Or, in other words, an area with an ENORMOUS demand for doctors. But before I think about where I want to settle once I am a doctor, there is still the big question of medical school. There are very fine programs across the United States, and I certainly would not like to tie myself strictly to Iowa.

There are some really nice medical programs on both of the coasts, including Stanford on the west and Boston College in New England. Hell, even a college in Chicago or something. All of those places would be really nice to attend, and surely a change from Cedar Rapids or Iowa City. Maybe, sometime really down the road, if everything plays out like it should, I’ll come back and do something nice for the community, because of course I can not forget about the place that aided me in becoming an actual doctor.

Man vs. Machine

In economics, structural unemployment is defined as the unemployment that occurs when there is an imbalance between skilled workers seeking employment and the labor market. Or in other words, when their skills are no longer needed. This happens all the time, throughout human history. Take for example, telephone operators like the ones you see in the movies way back in the day. With the invention of wireless and cellular telephones, those individuals became structurally unemployed. With the alarmingly quick increase in technological advancements it's no big secret that there are some positions that are being passed on from human to machine.

No variety of work is exempt from this truth. Air Force pilot? Unmanned aircrafts. Ford assembly line worker? Robot arms. Doctor? Who knows? And that's what I want to find out. Are those who work in the medical field facing competition, albeit how slight it may be, from machinery? Will there come a time that a collection of metal parts wired to a circuit board are able to do the same task that someone who spent more than half the life they've lived learning how to do? Most would argue against that. They'll say that nothing can beat the sheer instinct and gut that a real human being has. That no matter how advanced healthcare might get, it can not ever function without a certified, old school DOCTOR there on the scene making sure it all works.

Some people however, might be strong advocates of this. Surely it would bring the costs associated with healthcare down, considering the lack of doctor requiring a six or seven figure salary. And a programmed robot just doesn't mess up... a doctor who has been operating on patients for thirty years and can slice open someone with his eyes closed is still human, and might cause accidental injury. If a machine breaks, you take it out back and throw it into the dumpster, but an old man is going to ask for a pension. I don't doubt that there are very nice perks associated with using machinery instead of human beings to do some tasks. Especially the dangerous, meticulous tasks that medical professionals are asked to do.

But could they really find a machine that can sit down with a family and explain to them that their father has only a few weeks left? Could they create an inanimate object capable of sitting down with a patient and discussing how their day went, and how they've been feeling over the past few months? Of course not. Like no other profession I think, doctors are sometimes almost required to have a human side. You're dealing with sick people and their families. I sure as hell would not be interested in taking my sick grandparent to a humanless operating table. In a field that is very sensitive to human feelings, I think it's just overall a bad idea to install a cold piece of metal to take the place of the doctor that people trust with their lives.

Types of Doctors

I haven't thought much about what I want to specialize in after Medical School, throughout this post I will explore a few paths that at least sound reasonable to me. I know though, that I don't want to pursue any type of surgery, I'd rather stick to something less patient oriented. I think the coolest part about medicine is its sheer complexity and vastness. If you look at say a football team, lots of people have no realization of how many people are actually on the staff; they assume its merely the players, and at most a few coaches. When in fact most NFL team rosters are upwards of 60 people: players, head coaches, position coaches, managers... you get the point. Or a better example might be the crew involved in making a movie, those dozens and dozens of names scrolling through the credits all had something to do with creating the final product, even though they don't see as much glamor and are generally hidden from public view. Similar is the case of hospitals and all of the personnel they employ.

Ideally, I would like to have a career that both incorporates my medical knowledge and skills, as well as any other skills I have and like to use, such as working with technology. I looked around for a bit and discovered this. Radiology seemed like a pretty appropriate field, although they are physicians, they primarily deal with technology in various ways: CT scans, x- rays, MRIs, etc. A little farther down in the article, clearly stated was that 13 years of post high school education and training and required in order to get a shot at becoming a successful radiologist... meaning I'll be 31 before I officially start working........ That's kindergarten through senior year all over again. So I don't know, I'll keep looking around maybe I'll find something a little more reasonable than this.

A Day in the Life of Dr. A, vs. a day in My Life

Becoming a doctor is no easy task... everyone knows that. But for most, it stops there. They never bother to think about what it's like after they become one. This could be for many reasons, but perhaps the most important one is that they are never around any one in the field, making the whole thing seem very alien to them. Personally, I know a handful of doctors, friends, parents of friends, etc. and recently I've been getting curious about how they live their day to day life. The daily life of a high schooler and that of a medial professional are quite different.

So I made a quick comparison of both of our days, starting from when we first get up in the morning. Dr. A wakes up promptly at 5 AM, every single day, no matter what. As for me, I usually get up sometime around 8 or so, considering I don't have to be anywhere until 9. He's in the hospital by 6 AM, where he is promptly greeted by a series of appointments, checkups, trips between the two hospitals here in Cedar Rapids as well as the private clinic he works for. Enjoying a lunch break is a rarity for him he says; sometimes he's holed up inside the hospital for so long he couldn't tell you the time of day it is outside. Me on the other hand, I'm at school from around 9 until 3, with one of those hours strictly devoted to lifting weights in the gym, not exactly a class per Se... I also partake in a lunch break every day, no matter what. He may get home as early as 6 in the afternoon, but there really is no telling how late his work might keep him.

One weekend out of every month, he is on call. This means that anytime during the day or night that weekend, he can be called into work. His beeper can go off during dinner, the Super Bowl, or at 3 AM in mid December; it doesn't matter, if it goes off, he has to race to work. Sometimes he says, it might go off 5 minutes after he gets home from an 8 hour hospital session he just finished. I work one day on the weekends, and I'll be damned if I ever answer the phone if I see a call from anyone related to work trying to get a hold of me. If I wasn't scheduled to work that day, it's close to impossible to get me to come in.

All that is fine though, during the summer I was working two jobs everyday, usually up to 16 hours a day, about 4 days a week. So I know I'm capable of those long hours into the night, the real question here though is: am I prepared to do that for the rest of my life? I would like to continue on with my hobbies once I grow older as well, and I think that becoming a doctor might get in the way of that. Once Dr. A gets home, he's done for the day. No real hobbies or anything like that, just from work to bed, everyday. And by far, the biggest thing I'm not liking here is the whole being "on call" thing. I wouldn't be able to do anything, because at any given time, I know I might get called into work. I'd be like the guy in class without his homework done afraid that the teacher might call on him to explain something from the assignment.

.45%

I just finished Better: A Surgeon's Notes on Performance the other day, and I can easily say it is one of the best books I have ever read. All three sections of the book were masterful; every chapter had a catch to it that made it seem better than any other one before it. What I found to be my favorite part about this book was how Dr. Gawande could take something that seemed so irrelevant and meaningless to any higher purpose and show you just how vital it was. Every anecdote he mentioned took the points he was trying to make and turned them into very real life situations that anyone in the medical field will have to deal with, no matter what you think.

There were times in this book, especially near the end, where it felt like he was talking to me specifically.

For instance, one of the chapters found in the third section, the ingenuity one, was discussing the lethal disease Cystic Fibrosis and how America is dealing with it. Cystic Fibrosis is something that you are born with, and because of the genetics, you can never know if you will get it. It's what's called a recessive gene, which means that the only way you could inherit it is if both of your parents had it and they passed it on to you. This makes it very much more complicated because then most people never find out until the disease has matured in the body. One of the strongest symptoms of it is the accumulation of mucous inside of the lungs, making it increasingly hard to breathe. Until eventually, it kills you. People who find themselves inflicted with this also find themselves in a daily struggle against it. They must endure, at least twice a day, physical pain as someone bangs on their chest and various points across their body trying to force the mucous out of their mouths. Regular doctor appointments, something that would already annoy most people, are something they also have to participate in for the rest of their lives. Along with various medications, etc.

The average lifespan of someone born with CF was about thirty some years. Recently however, this number has gone up because of the aggressive new treatment methods that have spread across the United States. Which is where I go back to what I was saying earlier about Dr. Gawande talking to me. In one clinic where CF is treated, Gawande interviewed on of the doctors, he'd been there for decades, and in the last ten years, not a single victim of CF has died. The oldest patient they had at the time was over sixty years of age. What was his trick, was what Gawande was curious about. The doctor explained how the well being of a patient could be analysed by seeing the percent at which their lungs functioned: 80, 100, 110 (if the person's lung was functioning better than that of someone without CF). In one instance, there was a patient who's lungs were at 99.5%. That didn't cut it for this man, and he continued vigorously treating this patient until lung functionality was 99.95%. 99.5%...99.95%... if I were in his shoes, you better bet that I would have stopped at the former number, and been very proud of myself. But in fact, in order to be successful in medicine, a doctor always has to try until there is absolutely nothing more he can do.

When it comes down to those fractions of percents, .45%, when it comes down to staying up until the wee hours of the morning to deal with a patient, or working double time over the weekends, that is the difference it takes to be a good doctor.

Some People Would Call This Beautiful...

Here is a short video I found on YouTube of a woman delivering her child through a Caesarean Section. I have never seen something like this before and was actually quite surprised to find soemthing this gorey on YouTube. Everyone sitting around me just flipped out after seeing this video, but personally I can't see why people are so scared of it. I wouldn't go as far as other people and call it "beautiful" or anything like that, but it's definelty interesting how medicine has progressed thus far. I just read a chapter in Better where Dr. Gawande just talked about this very same thing.

In order for something like this to go smoothly, without any fatal accidents, so much has to go right. Gawande discussed some stories where women were in labor for absurd amounts of time, like 39 hours and crazy things like that. C Section births are almost always used as a last resort, because of the fact that its a full blown surgery where the doctor literally cuts the woman's abdomen open, and usually because women are just too scared to do it.

Like nothing else in human history, human birth has existed ever since the dawn of time obviously, and those in charge of seeing it through have always been pressured to make it work better. Child and maternal fatalities at one point were a common thing, most women would die because of infections, being in labor for too long, etc. And lots of infants would die from injuries they recieved during the labor process itself. In the medical community one was regarded as sort of a savior if he or she was to discover a new technique or invent some sort of contraption that would aid in the process, such as "forceps", or basically tongs used to pull the kid out if it's somehow wedged inside the mother and can't get out.

By far though, the Cesarean section is one of the strangest operations I have seen.

A Couple Things to Think About...

You can not turn on the television and flip to any news channel without at least seeing something related to the current healthcare system of the United States. It is the single most discussed issue in politics right now... and with President Obama's recent signing of the Bill into law, everyone from Bill O to high school teachers feel their obligation to tell everyone exactly what they think about it. And until now, I have not seen a professional in the field of medicine discuss their feelings about it. I've had light conversations with doctors before, and the handful that I spoke to were all in complete favor of "universal healthcare." I have a few questions of my own though... what exactly does this healthcare bill mean for this field of work today, and down the road; how will salaries be affected, if they are? What exactly do doctors think they owe the public, if anything at all? Is there a line to be drawn between politics and medicine, and who decides?

The first place I decided to look for answers was in my book, Better. Of course, Dr. Gawande had much light to shed on a couple of these questions, under his "doing right" virtue. He himself briefly mentioned his stance on the issue, with the generic "universal healthcare for all" response, note however, that this book was published sometime in 2007, quite before the current debates. Regardless, he had a chapter, "What Doctors Owe," where he discussed the issue of malpractice lawsuits. He heavily explored the touchy subject of whether or not doctors actually owe anything to society. He spoke with a few other men in the field, who told him that a doctor was simply "a business man, nothing more, nothing less." That he was comparable to an accountant, or an electrician. He provided service in exchange for pay. The idea that doctors are burdened with some sort of extra, moral obligation to society sounded outlandish to this man.

In a time where some medical procedures cost upwards of tens of thousands of dollars, has doctoring been reduced to a business transaction, devoid of any humanity? Why does it cost so much? Is this simply those in charge jacking up the price tag simply because they can? Frequently, I mention the importance I place on the money I will make in the future. From the looks of it, I seem similar to the doctor Gawande interviewed, careless about the human side of the work, and I do not want to be that way. I made my decision to enter this field originally simply because I wanted to help society in anyway I could, if I was solely chasing the money, I guarantee you there are ways that I could earn bigger paychecks, but I do not want to pursue in those routes.

So, assuming this bill lasts into the future (this is a pretty big assumption considering the intense opposition) and serious restructuring of this sector of the economy is undertaken, what does this mean for doctors in particular? I've heard almost two, almost polar opposite, answers to this question, dependent on the political view of the answerer. I've heard that this may increase the number of people insured, which in turn would increase the demand for doctors. I've also heard that the new insurance policies are going to drastically reduce physicians' salaries because they directly benefit from high insurance costs... I can't really tell you who I believe. If the latter is the case, I will find myself having to choose between money and the other reasons I choose to pursue medicine.

Just a couple things to think about...