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.

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

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.

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?

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.

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.