I write this from the Midwestern United States. My home. A generally underserved region. I’m a young doctor near the end of my training. My generation, I think it’s safe to say, has in large part bought into the general process of medical education, the natural progression through training, and the accompanying stressors and debts that are a typical part of the experience. Burn out, they say, is at an all-time high. And storm clouds are on the horizon, are they not? Our population is aging. We’re unhealthy. We’re in debt. A drive through small-town Midwest communities will generally confirm the sneaking suspicion that we’re not thriving. We’re awash in consumerism and a placeless popular culture. How can we encourage doctors to come home and serve well? A few thoughts come to mind. Minimize debts The more we upcharge for medical education, the more we foster an environment of self-service. We need to run the tightest financial ships possible with the goal of getting the next generation back home. I’m talking about bare-boned, clear-sighted educational operations. If we won’t change, we should at least stop expecting classes of debt-laden graduates to be interested in modest earnings in modest places. But ideally, we should champion frugality and a sense of obligation. Wendell Berry put it well. “[Educational institutions] have made [education] a commodity–something to be bought in order to make money … To make a commodity of [education] is to work its ruin, for, when we put a price on it, we both reduce its value and blind the recipient to the obligations that always accompany good gifts.” Avoid over-specialization Are we too naive to think that some among us pursue sub-specialization as a means to an end? Would some not be happy as generalists, if it would only pay to be one, or if the debt-to-income ratio was different? If we would serve well, we must not be too specialized. As I think Berry has noted elsewhere, the more we sub-specialize, the more we detach ourselves from common experience. We hold fast to illusions that we are near to the truth when all we have are hypotheses. We hide behind vocabularies that mask our ignorance. The question really is this: what are the realities of the matter? And what do these realities mean in the real world to our patients? Oh, how our home places cry out for generalists! For doctors who meet patients face-to-face, speak in a way they can understand, and care in a way that is tangible. Prize common sense Don’t you remember what they told us in medical school? “Ask the patient what they think is wrong, what they are worried about.” Many have laughed this off. “Never trust the patient.” Objectivity, scientism, and rationality are the name of the game, kid. But I think we’d all agree that the answer is somewhere in between. The art of medicine (and it’s dying, isn’t it?) requires a straddling of the fence. A certain humility, a lack of trust in one’s own faculties, and an ability to listen and muse. A pursuit of common sense. Let me tell you. If your patient picks up on a certain humble spirit about you, a listening ear, and a common-sense approach, you will be miles ahead. Conclusion Head down, they say, you can’t fix all the big problems. And truth be told, we can’t. But maybe we can start along these lines. Minimizing debts. Encouraging the pursuit of obligation, generalism, and common sense. Perhaps from here some of us can begin to serve our home places more effectively. Source
