Becoming a Doctor for the “Right Reasons” – Should That Really Matter?

Posted by
January 25, 2009

rightreasons

NOTE: This is probably the most controversial article on the blog. I myself learned a lot from the discussion in the comments that followed, and I am willing to admit my current thoughts on this subject are quite different from when I initially wrote this. However, I think there is great educational value in keeping this article and the comments up. That being said, I would appreciate it if people read all the comments and my responses before making judgments about my perspective on the issue, as I think my initial article doesn’t explain my point of view all that well, and can lead to misinterpretations of my thoughts.

During elementary and high school, I felt as if numerous sources in society were encouraging the concept of “nobility” as the greatest thing in the world. Things like school and the media were constantly championing ideas like volunteerism, servant leadership, environmentalism, etc. to the point where it was suggested that being a “good, noble” person involved thinking and acting with those ideas in mind.

And while I myself was swept up by those ideas, especially during high school, I began noticing some problems when I entered university. I started realizing that issues aren’t as simple as we often make them to be. For instance, bring up a random high school discussion on the environment, and you often hear things like “yah, coal plants are bad! We should get rid of all of them and power our cities completely with solar energy” followed by nods of agreement. But then if you do a bit more research, you start to learn that solar panels are currently pretty expensive as well as take up a ridiculous amount of space, such that it may just not be feasible.

It seems that the more you know, and the more open you are to possibilities, the more complex the world becomes.

The concept of nobility is particularly prevalent with “premeds” and their interest in medicine. A lot of students seem taken by the idea that it’s good to be pursuing medicine for the “right reasons” – usually this refers to pursuing medicine for the sake of practicing medicine, often driven by the desire to heal others, improve lives, or an interest in a specific field of medicine. Conversely, these same students usually see it as sort of taboo to be pursuing medicine for the money or prestige.

Personally, while I am generally interested in people’s motivations for what they do, I don’t think it is right to judge a medical school applicant solely on their intentions. I think it’s wrong, and kind of illogical, to immediately associate noble intentions with good and not-so-noble intentions with bad, in terms of being a physician.

The Patient’s Perspective

If I am a sick or suffering patient, I want a doctor who can help me. I could care less if he is the most passionate physician – if he can’t help me, then I’m not better off. For me, and I think for most patients, the most important thing is that our physician is competent enough to help and treat us. I don’t see a physician to admire her dedication and love for her job – I see her because I need to be helped. In short, I’d much rather be a healthy, living human being saved by a physician driven by money and prestige than dead because my physician was incompetent but noble.

Of course, you could argue that a more passionate physician is likely to go above and beyond for your care, but when it comes down to it, I feel that a physician’s competency is way more important than their motivations.

It’s Still Like Any Other Job

When you get rid of all the smoke and dust, being a doctor is still a job. It sort of irritates me when I see students putting the idea of a physician on a pedestal and seeing it as some sort of magical career. It also annoys me when I hear about students in medical school calling themselves the “cream of the crop” from undergrad programs and stuff like that, as if being in medical school means that they are “better” than other people in aspects that matter more than anything else.

It makes no sense to view being a doctor differently from any other job. There’s no reason why I should be obligated to have certain ideals or values about money or prestige if I am a physician compared to any other job.

How many times have you taken up a summer job solely for the money? Does it make you a bad person if you chose to work for more money at a computer business instead of protecting and saving lives as a lifeguard at the local pool for less?

So why is it so bad even if someone pursues medicine only for the financial stability / success it could bring?

When it comes down to it, the only reason I would care about someone’s motivations is if it affects their performance. And I doubt you could find a strong enough correlation to show that physicians driven by money and prestige are significantly worse at their jobs than physicians with more “noble” motivations.

I mean, while I’m sure some people will contend that these not-so-noble intentions could create lazy physicians, it’s just as possible for these intentions to produce positive results. If a doctor wants to make a lot of money, they are going to work efficiently and try to see more patients (if you are one of those patients who hates sitting in waiting rooms for hours, you might like this). Or if they are seeking prestige, they are going to work harder, take on more difficult cases, spend more time doing groundbreaking research, etc.

We Don’t Even Analyze Noble Intentions for Other Jobs

If I am business owner looking for someone to manage my store, I want someone who I think would do a good job and accumulate the most profit possible. I mean, would I really care if someone is genuinely passionate about managing the store?

Or if I am interested in hiring a student to mow my lawn for the summer, should I not hire him because he doesn’t absolutely love cutting grass?

Or if I am the general manager of a sports team, I wouldn’t care if the best player in the league is driven only by money and prestige, and is not genuinely passionate about playing the game. My goal is to build the most competitive team possible, and if that player helps me win, then I’m happy to sign him regardless of his motivations.

So why the double standard with a career in medicine?

I think it’s because of this obsession with nobility that we obtain through our youth. We become sort of idealistic, and think about people as “good” or “bad”, though I’m still trying to figure out why this is particularly prevalent with medical careers.

All in all, I don’t think it’s quite fair to be so quick to judge, and I think you are missing out on a lot if you are too busy forcing certain idealism on others instead of stepping back and thinking about why other people are viewing things differently from you.

Related Posts:

Skills

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  • sally

    WOW

    this post is exactly what i am thinking!

    its true society frowns upon those who pursue medicine because of the money

    i agree money shouldnt be everything but it is a good way of motivating others. Everyone wants a career that stabilizes them finacially too.

    if doctors werent rich (or well off), if they earned just enough to get by, we would not have the same amount of people being as pasionate as they are for medicine.

    THANKS JOSHUA for discussing this topic!

  • sally

    i love the businessman and athelete analogy!1 its so true, noone cares for they intentions, all they want is getting the job done well!

  • Joshua

    Hey Sally,

    Glad to hear you can relate!

    I just wanted to mention that I don't think that we should necessarily ignore intentions, just that I don't think it's fair to completely judge someone's ability to be a good physician solely on their intentions.

    For example, it's possible that someone who is only driven by the money and does not love their job as a physician might end up being unhappy in the long term.

  • tim

    You raise some interesting points Josh. However, just like your original premise "it seems that the more you know, and the more open you are to possibilities, the more complex the world becomes." – "being a doctor is just a job" is indeed a complicated issue.

    You point out some good points, about competency, getting the job done, performance. However, there are patients who would rather have a caring doctor than a competent but rude one. It's also dangerous to treat medicine like a business, because it's hard to measure the true value of patient care. And medicine, although is technically a "job", has many factors that make it more than just a job.

    Long hours, dealing with death and disease, having someone trust you with their life, putting a patient's well being and health before yours. The responsibility, privilege of caring for the sick, tolls and uncertainty definitely set it apart from most "jobs"

    I'm sure you already know it, the career of a physician is somewhere in between. It's not quite as idealistic as many people make it out to be and you can't entirely apply business principles to it.

    My perspective is that becoming a doctor for the right reasons do matter. Because if you have the right motivation, you will have the right attitude, and if you have the right attitude, you will sincerely serve and care for your patients.

  • Joshua

    Hey Tim,

    You bring up some really good points there. I think a mistake I sometimes make when I write is that I might come off one-sided, even if I'm not actually thinking that way.

    While I guess you could argue that someone who enjoys practicing medicine is probably more likely to have a good bedside manner, I'm not sure if you can actually find a strong correlation between how nice a doctor treats their patient and their motivations for medicine.

    Based on people who have spoken with him personally, I know one of my physicians is very money-driven but he is one of the best physicians I've ever had – he has great bed side manner, and I feel he spends the perfect amount of time seeing my case and explaining the situation to me. Conversely, I remember a physician I had when I was younger who obviously loved her job, but I thought she didn't do a great job. Small sample size, but you get the point.

    I guess we'll have to agree to disagree on the idea of being a physician as a job. I feel like every job is unique in its own ways, and so in that sense, I don't see why medicine should be seen as significantly more unique such that it's set apart.

    All that being said, I do think right reasons matter too – but that's only because I have my own ideas about what's important in life. Ideally, I would like to see physicians who genuinely enjoy practicing medicine, because I think they would be happier than physicians with other motivations. But to be fair, I would like to see that for people doing any job.

  • sally

    Tim brings up interesting points.

    U cannot measure the value of healthcare

    but i still agree with Joshua, healthcare is a business

    Illnesses that are more common, and have patients that are willing to pay a lot of money, always are the ones being researched one.

    Havent you noticed that for rare diseases like "Xeroderma Pigmentosum (being allergic to sun) might never have a cure. Why? because very few people have them.

    The public might say its because its only a few people that have it so why use all our resources on it

    but what about the few people that die becaus eof it? a life is still a life

    anyways i am sorry i'm going off topic

    my point is healthcare, o being a docotr is a job. Without prospects or wealth, very few people can live on "passion" and "nobility" alone.

  • Joshua

    Man I explain myself really badly sometimes.

    I'm not trying to say that health care and medicine as a whole should be viewed as simply a business.

    I think pursuing activities for the sake of pursuing them, be it medicine or anything else for that matter, is probably beneficial for everyone in a vacuum.

    The main point I'm trying to make is that I don't believe it's fair to judge whether a person would make a good physician solely based on their motivations. Some people believe that if your primary motivations for medicine are money or prestige, you are not only unqualified to be a physician, but you won't be a good one. I disagree with that view.

    I do think you should take motivations into account, but that should be but one factor in a myriad of other factors. How much you value motivations in your overall evaluation is up to you.

  • Susan

    Thanks for bringing up this interesting topic, Joshua. This is something I always ponder too. I think this is not only for medicine but is also prevalent with other high-paying jobs which are naturally steroetyped by the public in the case of money. I often hear people say whoever study Commerce are driven by money, and are somewhat "mean".

    There is nothing wrong about money. I think no physician would not want to be finacially rewarded regardless what their motivations are. I think we need focus more on how you treat money after. Are you going to buy fancy cars in order to brag with your neighbours just because you are a doctor and earn lots of money? Or is it because you want people to praise you because you are intelligent and are qualified to be a doctor?

    The key point I'm trying to say is as long as you don't see yourself superior than others because of how much you earn or how high your social status is, you are okay to be motivated by money or pretige. Of course, passion and nobility will be a bonus if you have them.

  • Joshua

    Hey Susan,

    I completely agree with everything you said.

    I do think Tim brought up a point that I might not have addressed too well yet.

    I do want a physician that goes above and beyond (which brings up another question: is it fair for me to ask so much of a physician?). I do want a physician that isn't just doing the bare minimum, and it's quite possible that those with "right intentions" and are genuinely passionate about medicine will do this more often.

    That being said, competency is a very important factor to me, which is why I believe while intentions should be a factor, it can't and shouldn't act as a "cut off".

  • Marta

    "For example, it’s possible that someone who is only driven by the money and does not love their job as a physician might end up being unhappy in the long term."

    I think you're not giving this statement enough credit. Money and prestige wear off in time. I've encountered a great deal of doctors who, you could tell, had been in the profession for quite some time, and who were now lousy at it because they just didn't care anymore. This would imply that "treating patients" had not been their original motivation for becoming doctors. I think that if you want to make money or have prestige, you should become something that doesn't play with people's lives on a daily basis, and I find it ridiculous that you're comparing being a doctor to mowing a lawn.

    I think that the stereotype that "being a doctor or a lawyer isn't just like any other job", because it isn't. You can't possibly compare most other jobs to it. I would include passing laws (as in being a part of the governement) under this umbrella, because these careers directly impact people's lives, unlike say, a secretary or a plumber. Not to discredit any other profession, but there's a definite difference.

    And not to sound harsh, but I think that your mindset is what's wrong with medicine – why in the US people get put out on the street if they don't have the money to pay for a procedure, and why there's corruption and greed in the system. If everyone who went into medicine genuinely wanted to help people, I think it would be much less of a "business", and it would truly be much more beneficial to society and to the individuals being treated.

    There are many professions where you're given the same pay, if not more, but the reason doctors always had the prestige is because of the nobility. Saying that there's need for nobility is discrediting the prestige, and you might as well be something else.

    There are many morality calls one must make as a physician, and I would much prefer a doctor who cares about me as an individual, rather than one who just waits for his paycheck, especially in the specializations in medicine, with private practices.

    Maybe you should consider another profession if this is how you feel?

  • Marta

    Sorry, I didn't re-read, I meant to say that I think the stereotype is there for a reason.

    And also saying that there's NO need for nobility is discrediting the prestige,…

    I was revved up, what can I say.

  • Joshua

    Hi Marta,

    Thanks for your comments. I feel like my article is coming off as if I have an extreme view on this issue – I'd like to clarify that I don't. Maybe it came off that way, but that wasn't the purpose. I was simply playing devil's advocate to those who believe that motivations alone should be an initial cutoff for the medical school application process – and idea I just can't support, because I think it takes on an extreme view of the issue, and one that I don't think is best for medicine in the long run.

    While this shouldn't matter at all for the sake of my argument, I felt it important to reiterate that I am personally genuinely interested in medicine and the role of a physician. Prestige and money are not big motivators for me – pursuing meaningful work has always been of much greater importance to me. That's why I struggled quite a bit this past year thinking about whether I even wanted to pursue medicine. I'm pretty sure if you ask anyone who knows me well and has had deep discussions with me about the issue, they would tell you the same.

    But I don't believe that just because I genuinely want to pursue medicine for the sake of practicing medicine, I am immediately a better candidate to be a physician than those who aren't. Obviously many people disagree with me, but that's how I feel.

    Personally, I think it would be great of all physicians genuinely loved what they did. That would be super awesome. At the same time, I also think other qualities, like competency and skill, are also extremely important. But at some point, you're going to have to weigh the importance of these factors when you think about who would make the best physicians. Not every physician candidate is going to have the same levels of passion and skill – so how do we balance these factors?

    The point of my article was that I disagree with those who say that motivations alone should affect whether individuals should be allowed to become physicians in the first place. I think that is far too extreme.

    Again, I'm not saying motivations don't matter at all. My point is that I disagree with a very common, extreme view of them and am just trying to provide perspective from the other side.

    And like I said in my article, I think performance is the most important. Who is taking care of their patients the best? Who is making the best decisions? Who's to say that those driven by prestige and money can't still be fantastic doctors? Who's to say that those who are genuinely passionate about medicine won't have poor judgment and make bad decisions?

    And so I don't think we can generalize. I don't think we can say with certainty that anyone driven by money will make a bad doctor. And in the same way, we can't be sure that everyone genuinely passionate about taking care of patients will make a great doctor.

    It's about balance between all the factors, and that's the overall message I'm trying to get at.

  • Joshua

    I apologize for all these long comments, but you guys keep bringing up so many interesting points and ideas that you are making me think a ton, and I just need to get some of these thoughts out.

    I also wanted to comment a bit on the whole idea of how being a physician relates to other jobs. I understand the perspective that you want a physician who takes their job seriously, to the point where it's "more than just a job". You want a physician who is going to do everything in their power to make sure you get the best care and treatment possible, whether or not they are legally obligated to – because your health, and ultimately, your life is more important than anything.

    In that sense, I definitely agree that sentiment. I would of course want such a physician, not just for myself, but for everyone I know.

    That being said, some questions then are: Is it actually fair for us to expect this "more than just a job" concept from physicians? If so, why? Are there not other occupations you could also apply this to? And if so, what criteria is involved for identifying such occupations?

    Lemme know what you think.

    Thanks again for all of the thought-provoking comments – keep them coming!

  • Jai

    Why do good intentions matter-

    While I can agree with your point that technically being a physician is a job like any other they are some very huge differences. The first being the you are responsible for the care and well-being of people. And unfortunately many a time, competency will not be a factor in being able to help. While medicine has provided us cures for some of the worst illness, it still just a science. And there is a large percentage of the time where you will not be able to do anything for a patient besides make them comfortable and help ease their mind/pain. And also that of their loved ones. So while competency is needed, compassion and a sense of the greater good is equally needed.

    Additionally the road to becoming a physician is long and hard. Probably one of the longest and most costly of any profession. In the US it takes 4years of Undergrad, 4 years of med school, and then 3-7 years in residency before you start making good money. And then you still have to pay back student loans. So we are talking about anywhere from 12-17 years before it is just worth the money. That's a lot of time to put in just for money.

    "We Don’t Even Analyze Noble Intentions for Other Jobs

    If I am business owner looking for someone to manage my store, I want someone who I think would do a good job and accumulate the most profit possible. I mean, would I really care if someone is genuinely passionate about managing the store?

    Or if I am interested in hiring a student to mow my lawn for the summer, should I not hire him because he doesn’t absolutely love cutting grass?

    Or if I am the general manager of a sports team, I wouldn’t care if the best player in the league is driven only by money and prestige, and is not genuinely passionate about playing the game. My goal is to build the most competitive team possible, and if that player helps me win, then I’m happy to sign him regardless of his motivations.

    "

    What I think you are forgetting here is the human component to medicine. Docotors help save lives, not win games and not make a profit, save lives. This is why we evaluate their motives. Additionally, using your example about football, you sign the guy who cares only about money to help you win, but what happens when you start to lose? Will this player continue to work as hard, will this person be a great team player, will this person help you rebuild?

    Another way to look at this is the job of parenting. Many are competent to conceive but does that mean they will make the best parent? No, because we judge parents on the ability to deliver love, emotional support, and provide the basic necessities. Basically we judge them on their ability to care for a life on multiple levels.

    So as people put their lives in doctors hands, hence why we judge their motivation. We believe those who care more and are motivated by more than just salary, will tend to do better in the long term and when it really counts.

  • Joshua

    Hi Jai,

    Thanks for your well thought-out comment, and I definitely agree with a lot of what you said there.

    I wish I could write this article over again, as I don't think I portrayed my ideas as clearly as possible.

    I'm not saying intentions don't matter. I do think they are important. I think a more genuinely compassionate person would make a better physician than someone who was less compassionate (assuming all other qualities equal).

    What I disagree with is how some people evaluate these intentions and how they use these extremely simplified evaluations in predicting who would make a good physician and who wouldn't. It's not that simple.

    For instance, we often associate inner thoughts and motivations directly with actions – i.e. someone who cares about people on the inside, will appear caring on the outside. This isn't necessarily a fair assumption to make, but it's one that we often do all the time.

    I know some people who are genuinely passionate about helping others, but are not very good at showing it – for example, if you met them, you would assume they are not caring simply because they don't make that aspect of themselves obvious. On the other hand, there are people who might care less, but are better at showing it when they do care. Who would make a better physician?

    My opinion is that we don't know enough information about these two types of individuals to determine that. Being a physician is more than just caring about people and how well you are able to show that. There are many more qualities we would need to assess, and my overall point to the article is that I think people are often mistaken if they only assess one aspect of a person's overall character/traits and use that as an overall evaluation for that person's suitability to be a good physician.

  • Lisa

    I agree with Joshua's point.

    A person motivated by ambition and money should not be immediately tagged as the wrong type of medical school student. Many students work hard in high school and university only because they wish to achieve something, or to show that they are better than others. These students worked hard and they earned their success. Sure, interest is as important. But being interested in something will make you take action, which is equivalent to taking action while motivated by other factors. Therefore the result is the same: action.

    Some say that the desire for money will wear off over time, that really depends. Especially with the current economy, would you rather have a boring but stable job or none at all?

    I also believe that "caring" is not merely a personality, but more of an action (yes, action again). Shakespeare once said, "All the world's a stage, And all the men and women merely players." If you act as a caring person on the outside (even if you don't have a caring personality), sooner or later you will become one.

    Lastly, I'm really glad that Joshua posted this article. I'm currently considering medical school as an option but I'm not quite if I'm genuinely interested in medicine or not. This article gave me a different outlook on the qualities of a medical student. So Jushua, thank you for that.

  • Joshua

    Hey Lisa,

    Glad you found the article insightful!

    It seems to me that the major reason why people concerned about physicians being genuinely passionate about medicine itself is because the health and lives of people are affected by the quality of care their physicians provide. Health and life are things most people value very highly, and there is concern (and probably rightly so)that people who do not really care about the people they serve might not be as focused. And while mistakes can happen in any job, I'm sure we can agree that physicians are some of last people we would be okay with making mistakes.

    That being said, I'm sure there are several other careers where mistakes would really hurt us as well, and I'm not sure of students who are interested in them get the same idealist approach that medicine does.

    Definitely interesting to think about.

    That being said,

  • Kasia

    Hey Joshua,

    Thanks for blogging, it's an interesting read!

    Here's a thought:

    "So why is it so bad even if someone pursues medicine only for the financial stability / success it could bring?"

    I'm a 3rd year nursing student and currently volunteer twice a week in a hospital in the pre-op/anesthesia department… a few days ago there was a need for a translator in the ICU and I happened to be able to help out… long story short, I helped the doctor communicate with one of his patients that he'd no longer have use of his legs and would require breathing assistance in order to live. The doctor also wanted to discuss the patient's beliefs about what kind of quality of life he'd have and which direction he'd be more inclined to… basically to continue living like that or to die. While this had very little to do with me, or my feelings, I have to say that it hit me hard emotionally, spiritually, and even physically. One of the many thoughts I had bouncing in my head was, "I'm not sure if this would be any easier to deal with in the future if I made twice, or even three times the money." This is why I have to challenge your statement. It's not "bad" to persue a professsion in medicine for the money and prestige, but foolish. There is no amount of money in the world that can rid you of that awful feeling in your stomach once you've gone home for the night, leaving a patient stranded in such an unfathomable position. In fact, for some doctors, I'm sure that if it was possible, they'd give away every last cent they have just to ease the suffering they see. As for prestige, it quickly escapes out the door once you've been humbled in such hopeless situations. In fact, all that glory rightfully belongs to the patient… because in some strange way, their hardships make you thankful for your blessings, and makes you appreciate being alive and well much more than you could ever imagine.

    I wish you best of luck as you start med school and hope you persevere when you run into similar situations. All the best. :)

    • Mimi

      may i use your story for my english paper?

  • Joshua

    Hey Kasia,

    Thanks for sharing your story, and I'm glad you're enjoying the blog.

    I agree that some physicians who go into the field for prestige/medicine may end up realizing that it wasn't worth it because of the challenges they will inevitably end up facing, and may not want to endure, such as those you've mentioned. I do think that individuals interested in entering the field need to really contemplate their decision and all aspects involved, and not be narrow-minded about the long term implications of their decision. Medicine really isn't for everyone.

  • Ali

    I disagree with you. Although it's true that we should judge people based on job competency, it IS true that "nobler" people make better doctors.

    I shadowed a few doctors this last summer for a few weeks, and I found that people who truly care for their patients end up with the higher social status/more money, etc. There is a strong correlation b/w what you TRULY love to do and how well you do it. Remember during high school when you wanted good grades in every single class? Is it just coincidence that the classes you truly enjoyed (for me it was chemistry, physics, and calculus) you did better in and the ones you didn't like as much you did worse in?

  • Joshua

    Hi Ali,

    I agree with you that all other things being equal, a physician who genuinely cares about their patients will be a better physician than one who isn't.

    My overarching point though is that nobility or whatever we decide to call this is not the only important factor in what makes a good physician, and sometimes we need to settle for different balances of these factors.

  • Arthur

    Hi Josh,

    I read the comments and your clarifications and the entire thing makes more sense to me now. I think you make an additional good point in your comments that using "nobility" alone to base a cut-off line would be inappropriate.

    However I have some beef for this point… you say that "we don't even consider the noble intentions for other professions" and you use the examples of a lawn-cutter and an athlete. As someone already pointed out, lawn mowing obviously cannot be adequately compared with medicine, and as for athletes, some cases I thought of:

    - skilled but dispassionate athletes who are lazy at practices or are less willing to play as a team

    - athletes who do not perform well after signing a long-term contract

    - athletes who mysteriously perform much better during the last year of their contract (and then are disappointments after a big free-agent signing)

    - (as Jai mentioned, an athlete who signs to help you win, but does not play as well when the team starts losing, is a poor team player, is unwilling to help team rebuild)

    I find that in the above cases that these motivations would be very important because they are intricately linked with (future?) performance. Say player A has a history of the above "non-noble"/selfish qualities, and player B is a consistent hard-working player who has taken a discount in his contract. In this case, I believe that even if the skill and performance of player A has been higher than player B, player B may end up the "better" player.

    So re-applying to the medical profession, I would think of it as a more "noble" doctor with less skill / lower "performance"(as measured at graduation?) may still end up a "better" doctor [perhaps in the future?], for possible reasons such as hard-work translating into more willing to stay up-to-date and practice self-improvement as medicine is highly evolving, as opposed to a "less noble" doctor.

    So a new point I'd like to hear your thoughts on is the effect of time. Perhaps "noble" motivations may be useful to predict not the test scores at graduation, but on-going and future performance?

    Also, your counterexample of a top athlete not passionate about their game may be very difficult to find, because it takes a lot of dedication, perseverance, hard work to get to the top. Can there be a comparison with medicine here? Does the medical school process naturally weed out most who lack the motivations other than money/prestige? Are we leaving "selfish" albeit skilled and competent doctors behind? Are "selfish" albeit skilled and competent athletes left behind??

    Actually, are these athletes (selfish+skilled) the best of the best i.e. to stay in major league?

    Then, do doctors have to be best of the best?

    (which seems like a point you are trying to convey)

    (i.e. can society afford only licensing the best of the best doctors?)

    One more thing: you use as a counterexample: "If a doctor wants to make a lot of money, they are going to work efficiently and try to see more patients"

    Perhaps because of the stereotype and negative connotations of non-nobility, but a doctor working more efficiently for money sounds like a doctor who will miss symptoms or not provide enough consideration (an efficient doctor is better, all other factors equal, but it seems there would be a correlation between a "noble" doctor taking his time and sacrificing efficiency/profit for perhaps even "better" performance)

    Sorry, one last point to bring up (responding to your comments): Is it actually fair for us to expect this “more than just a job” concept from physicians? If so, why?

    - health, quality of life, as you mentioned

    Are there not other occupations you could also apply this to?

    - law, politics

    - but by stretching, you could also include: law enforcement, business (making decisions affecting jobs, health and safety, long-term environmental effects), engineering

    - I believe the reason for the stereotype of required nobility is because medicine most directly affects health and quality of life, whereas the other professions appear to be more indirect. I would say that the closeness of the effect on quality of life appears to be proportional to the amount of required "nobility" as perceived by the public.

    - You ask is it fair for medical practitioners to be subjected to such scrutiny (compared to other occupations)?

    - I only have more questions: how much closer is a surgeon, doctor, pharmacist, paramedic to health/life than a lawyer or judge sending someone to jail or even capital punishment? How about a politician making decisions regarding health care, education, or even war?

    Then what about business executives who might neglect the health and safety of employees?

    And engineers developing and deploying technologies that could drastically affect health and life?

    - Most of the occupations I suggested are actually designated by society as "professional" professions, which are society's most trusted members

    - We trust professionals with our well-being and lives.

    – We trust them to not to make mistakes

    – But also for them to be ethical and moral

    - We also trust professions differently

    - Doctors are probably the "most trusted" profession, so the demand for the most "noble" makes sense (but is it reasonable? fair?)

    - How much trust does a doctor earn by their skill/"performance"?

    - What about a surgeon (precision/get the job done)?

    - How much trust does a judge earn by their skill/performance?

    - What about a judge working only for the money and prestige?

    - Now that I think about it, there are many different lawyers out there… I guess I'm thinking more of prosecutors for public welfare? Do we trust them to deliver justice?

    - Can we trust a police officer to be fair if he is working for prestige and power?

    - Politicians??? Can they be trusted????? Shouldn't they be "noble"???

    - Possible anomaly: for the amount of trust society puts in engineers, "nobility" is almost a non-factor to become a professional engineer, save for the requirement of a "good character" reference and passing of an exam with an ethics component for a P. Eng.

    – Is it the perception of the amount of trust into a profession ? People put their trust in engineers in modern everyday life, but usually not consciously, so is that why "nobility" is not demanded?

    I've run out of time… Josh, your writing, topics, and comments definitely get me thinking!

    Arthur

  • Joshua

    Hey Arthur,

    Thanks for your insightful comment.

    I agree I may have generalized the application of nobility to athletes. At the time I wrote it, I was mainly referring to barrier to entry – i.e. in order to get into a professional league, we care much more about competency/skill than whether they truly love basketball. It’s true that a genuine passion for basketball may translate into a better player than one without it, but compared to medicine, I feel like the general perception in sports is that results/skills/performance/competency matters way more and what it took to get there matters way less.

    It would be interesting to try and do a study on what you suggested, but I think things like altruism, nobleness, etc. would be hard to quantify.

    Your question about whether medical students who don’t care as much are weeded out in the process is a good one, but I don’t think it will happen very often at all. Most students who get into medical school, regardless of their motivations, are the type who are able to work hard for what they want – and I think that’s the biggest factor in terms of succeeding in medical school. Most students here already have that quality, so unless they suddenly realize a passion in something else, I think they’ll stay.

    As for your question on whether a physician working to see more patients is potentially dangerous, yes that’s a possibility that we have to consider. I agree that efficiency is good, but not at the cost of quality of care for the patient. You also have to consider that physicians who are working inefficiently (i.e. spending more time than they need to with patients) may be doing harm by not seeing enough patients (recall how there are often long wait times for procedures/appointments). As with everything, balance is important.

    Yes, I think it is fair for us to expect a “more than just a job” mentality from physicians because we are directly affecting the health and lives of people. There’s a reason why we’re constantly being taught that being a physician is a privilege.

    You ask many other really good questions – I’m working on a new website now that’s better for discussing topics exactly like this, and it would be good to carry this conversation there.

    Again I’d like to say that I wrote this article pretty hastily, and I admittedly did not address enough points/ideas/perspectives as I should have, which everyone has thankfully brought up.

  • Arthur

    Thank you, Josh, for providing a space/forum for discussing such issues

  • Brian

    I'm a premed student and this post (and all the comments) were very though provoking, so thank you Josh for taking the time.

  • Joshua

    Thanks Brian, glad you found the post and the comments insightful!

  • Fong

    Great discussion. I was actually trying to find out what my motivation was to study to become a doctor and I just couldn't describe it into words. Then suddnly, I saw this thread. It's very interesting and made me think about it. thanks so much!

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