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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, September 21, 2006
    "The Glamour of Medicine"

    A few days ago I dropped into the hospital cafeteria to grab a quick bite of lunch. I wound up at a table for four with one of my partners, a podiatrist we both know well, and another MD newly on staff. I introduced myself and the talk meandered into personal backgrounds, such as where-did-you-grow-up and how-do-you-like-Los-Angeles. After some gloomy talk about the current state of health care, we started to talk about having doctors for parents (not all of us at the table fell into this category).

    "My dad tried to talk me out of going into medicine," I contributed. This is not unusual among children of MD's. Pretty much everyone in my med school class with a doctor for a parent reported that at one point or another, Daddy - usually it was Daddy - had tried to tell them that medicine is a difficult job and that it no longer pays commensurate with the work involved. (I do not include specialists here, though their opinions may differ on this subject. I am speaking of primary care because that's what I know.)

    At this point one of the older physicians on staff, a neurologist, joined us and we included him in the conversation. He told us his son had decided to go to medical school. "What did you think about his decision?" we asked, wanting some firsthand input.

    "Well, I tried to be honest about it. I told him what I like about being a physician and what I don't like. But he's been doing some volunteer work, and he was attracted by..." he shrugged. "The glamour of medicine."

    Simultaneously, the rest of us burst into laughter. The questions came thick and fast:

    "Has he ever had to sew up a drunk?"

    "Ever done a pelvic exam on somebody with bacterial vaginosis?"

    "Has he spent any time in the ER at all?"

    He chuckled good-naturedly at our cynicism. "It's what he wants. He's decided it's what interests him, and I said, 'Good for you.'"

    This discussion stayed with me the rest of the week. Usually the doctors' dining room isn't good for much except CNN updates and endless pontificating on the state of the world today. If I could vandalize their TV and get away with it, I'd do it in a heartbeat. But hearing what people think about this profession - would you defend what you do to somebody else? Is it worth it to you? - this stuff truly interests me.

    I have a standard quip for patients who ask me if I like being a doctor: "It depends on what day you ask me." The truth is, though, I do. I can't think of anything else I would rather be doing, or even of any other job I'd be suited to do. If a friend or relative were to ask me about becoming a doctor, I wouldn't tell them not to do it. Like my neurologist acquaintance, I would try to give them the most balanced picture that I could about what it's like to be a doctor. It might well involve phoning my hapless apprentice at three in the morning to complain about nonexistent chest pain or a UTI, just to make sure they get the full experience... but I'd be sure to include the satisfaction that comes with helping someone feel better or achieve a better quality of life. I feel lucky to have a job that has more meaning attached to it than just a paycheck, that has - for want of a better word - "glamour."

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