On occasion, I really dislike science—and that’s putting it lightly.
My application essays to medical school were full of statements like “I love studying the inner workings of the mitochondrial membrane” and “biochemistry is life’s greatest joy.” Back then I might have believed those assertions on some level (probably not), but what I did know for sure was that I wasn’t alone. I didn’t really know anyone who got into medical school that cared a ton about science—I just knew a lot of people who pretended to. It seemed to me that the pretenders actually did the best, often times clobbering those in the admissions game who actually had genuine passion for the science of clinical medicine. If our goal as a society is to provide the best patient care possible, obviously what you just read is troubling.
This dynamic creates some interesting results by the time you and your fellow classmates hit the wards. Suddenly, as the I-like-science-but-not-really medical student, you find yourself in great company: not with other physicians, not with your fellow students, but with your patients. In a strange twist of fate, your patient with heart failure cares even less about the pathophysiology of her condition than you do, and you eventually bond over your shared disinterest.
This might come as quite a shock to many in the medical community, but let’s face it: some of us just don’t care very much about the science behind clinical care, but we still always believe we’re right because we’re doctors and we care about helping people. Furthermore, if you test us on this knowledge (which we don’t care about, at all, in any way whatsoever), we’ll pass with flying colors. We might be geniuses on paper when it comes to understanding the basic principles of what we’re doing, but there is still something missing—some crucial element of passion that belies our impressive resumes and phenomenal test scores.
This can lead to willful ignorance about the consequences that our decisions may have, or worse, outright self-delusion. To those who argue that this distinction is irrelevant, take a look at the following quote by C.S. Lewis:
“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
This is just conjecture, but I think the whole problem comes down to a question of what it means to be truly genuine, especially when it comes to interacting with patients. The medical establishment rewards those who are able to work like dogs and suppresses their true desires and interests. It rewards the exact opposite of vulnerability. You have to cover up your faults, never let patients know what you really think, and above all look happy while all of these contradictions tangle up your rational mind.
The end result is a great amount of internal discord, and I think patients pick up on it. They know when we’re not into what we’re doing. They’ve been out in the real world their whole lives and usually have not spent years on end in the classroom. They know the difference between saying something and meaning something.
Intent and passion and vision are all overlooked when we think about how to get people to do stuff that they don’t want to do. In order to sell something you really have to believe in it. You can’t just pay lip service to it and hope that somehow down the line your words are translated into action. You can’t just tell a patient to do something because you know it’s the technically correct thing to do. You have to believe in it at a deep, spiritual level. And that doesn’t happen by reading textbooks and taking exams and pretending like you’re interested when you aren’t.
We need a paradigm shift when it comes to educating future doctors and patients alike. I no longer believe that our archaic system of memorizing and regurgitating on exams will be sufficient for patient care. The people this sort of system selects for are exactly the wrong types to motivate patients to change their lives. The research in medicine is much further ahead of the salesmanship, and it’s time for medical schools to recognize this. Admit people who seem like they care even if their grades aren’t the best. Look for those who are actually genuine, and if you don’t know how, figure it out.
There’s no scientific way to measure passion, but maybe that’s precisely the point.