On Becoming (and Remaining) a Doctor
Years ago, when I was applying to medical schools, I was frequently asked, “Why do you want to be a doctor?” In response, I regurgitated a series of bland justifications: I wanted to help people and make a difference in their lives; I was inspired by the challenge of diagnosing and fighting disease; I came from a medical family and had seen, firsthand, how satisfied my parents were with their careers. At the time, I was convinced that these were not only sincere answers, but ones that served my application well. Upon reflection, a decade and a half later, I chuckle at my responses. Not only did they lack originality, but they left out the seminal inspiration for my medical career: bones. Actually, Bones, as in Dr. Leonard “Bones” McCoy, chief medical officer of the USS Enterprise.
Dr. McCoy was my favorite character on my favorite childhood television show, Star Trek. Throughout much of grade school, my brother and I settled down daily to watch an hour of exploration of space’s final frontier. We didn’t care if it was a beautiful day outside or if there was homework to be done: Star Trek could not be missed. We never went so far as to attend a Star Trek convention, but I do recall owning (and even wearing) a blue Starfleet uniform.
There were lots of great characters on Star Trek: the charismatic Captain James Kirk, the intellectual Spock and the inflective Scotty. But Dr. McCoy was the most marvelous of all: passionate, principled, intuitive and as cantankerous as a cactus. He was also a peerless physician who made the job look exceedingly easy. Walking up to a patient in the sick bay of the Enterprise, Bones need only wave his medical tricorder—a saltshaker with lights and a hum—and he’d have the diagnosis. Then he’d aerate the patient with a puff or two of noninvasive hypospray, and voila, the ailment was cured. No needles, no blood, no pain, no stink, no discernible liability, absolutely nothing but easily applied medical technology. To boot, Bones could play the “doctor card” to get out of other tasks, punctuating the cop-out with lines like “Dammit Jim, I’m a doctor, not an engineer,” or “Dammit Jim, I’m a doctor, not a bricklayer,” or “Dammit Jim, I’m a doctor, not a coal miner.”
Who, I wondered, wouldn’t want to emulate Dr. McCoy?
Sadly, medical practice in the 21st century is not as easy for me as it was for Dr. McCoy in the fictional 23rd century. A diagnosis isn’t always apparent, and most serious complaints require invasive testing. Treatment is rarely as simple as a nasal spray, and everything I do is shrouded by the specter of medical-legal ramifications. Nonetheless, as I reflect on my fictional mentor, it becomes apparent how current medical practice is moving, perhaps inexorably, toward a Dr. McCoy-like future.
More and more, physicians rely on noninvasive testing for important information: X-rays, CT scans, EKGs, MRIs. And treatments have evolved—we now have a nasal flu vaccine, and pain medication can be given via a skin patch. Surgeries can be performed by inserting cameras through tiny incisions, and in some cases by using pulses of sound waves or lasers. Recently, I read about “proton beam therapy,” a developing technology that involves zapping malignancies with a beam of high-speed protons that deliver DNA-warping radiation to a tumor without damaging the surrounding tissues. Someday soon, writes William Hanson, MD, author of The Edge of Medicine: The Technology That Will Change Our Lives, proton beam therapy will emerge as a “medical tour de force, in which the patient walks into a room, lies down on a bed, and, for the minutes he’s there all of this magical stuff happens around him and to him, painlessly and silently, perhaps while he listens to his iPod.”
Such technology, while amazing, also highlights a fundamental transformation in the practice of medicine. Nowadays, the doctor-patient relationship is more about interpreting laboratory or radiographic tests and explaining the risks and benefits of treatment, and much less about hands-on artistry. Test-based medicine is more scientific and has less variation in quality, but its practice blurs the essence of being a doctor.
Dr. McCoy made doctoring look easy, perhaps too easy. Surely, any lowly officer on the Enterprise could have been taught how to use the tricorder and the hypospray? Was there really anything to it? I encounter many patients who have a similar attitude towards modern medicine. I frequently have patients come into the Emergency Department and declare, “I am here for an MRI,” or ask “Doctor, don’t you think I need a CT?” Sometimes these statements are justified, but sometimes I feel like boldly beaming these people to the land of reality checks.
Often, I appear more like a secretary than a physician: ordering tests, filling out forms, reconciling medications and documenting the hell out of all of it. This secretarial role, I’m afraid, is the future of medicine. While I’ll grudgingly admit that on the macro level this shifting role amounts to “progress,” it does make me reconsider those answers I gave years ago to the medical school admissions officers. It also helps me justify my writing “hobby.”
Most of the time, writing is not much fun. It is time-consuming, and inspiration is fickle. To be good, prose must be edited and re-edited, and editing is humbling and tedious. I already spend much of my working day in front of a computer, pecking at a keyboard, so I often wonder why I choose to do the same in my off-hours.
There are several reasons. First of all, writing helps me think and understand. Everyone has their own way of wrapping their head around an issue. For me, the best way to understand an issue is to write about it.
Second, in some circumstances, writing helps me humanize my medical care. To delve deeply into writing about one of my former patients, as I have done on several occasions, is to nurture the degree of empathy that I would like to feel for all of my patients.
Finally, I write because I need a lasting creative outlet. If I had any artistic talent, I would play music or paint still lifes; but I don’t, so I put words on the page. Maybe somebody besides me reads them, or maybe not. Either way I feel freed to return to the “in-the-door, out-the-door” nature of my medical practice and to be at relative peace with the monotony of medical charting.
I wonder, was “Dammit Jim” McCoy cursed by an identity crisis? Was he so caught up in being nothing but a doctor that he didn’t realize that a happy doctor finds an identity outside of his or her profession?