
Letter to an Aspiring Doctor - wormold
https://www.firstthings.com/article/2018/12/letter-to-an-aspiring-doctor
======
nickpsecurity
This is a great letter. I do want to pause on this, though, about doctors
prescribing opiates:

"The epidemic would have been avoidable if doctors as a whole had adopted a
more critical and thoughtful approach"

He could be totally right about causes of that problem in that time.
Currently, though, drug companies offer all kinds of financial incentives
anyone that will increase drugs use in ways ranging from BS studies to
incorrect info in textbooks to actual prescriptions. I've also read they give
free samples.

Examples I found in quick DuckDuckGo:

[https://www.bostonglobe.com/opinion/2016/04/11/medical-
resea...](https://www.bostonglobe.com/opinion/2016/04/11/medical-research-
financial-conflicts-interest-matter/FfGc04GpdBXztO6m3kcT1I/story.html)

[https://www.nytimes.com/2004/06/27/us/medical-marketing-
trea...](https://www.nytimes.com/2004/06/27/us/medical-marketing-treatment-
incentive-doctor-writes-prescription-drug-company.html)

[http://content.time.com/time/health/article/0,8599,1883449,0...](http://content.time.com/time/health/article/0,8599,1883449,00.html)

This stuff could've been going on a long time. Maybe back when the push to use
addictive drugs started. Or maybe that was just bad science like author says
with the _current_ push involving massive amounts of corruption. I say don't
forget what's going on in any current debate about drugs, though.

~~~
classichasclass
No, we didn't get free opioid samples. I can't imagine many docs got paid,
either (I certainly got neither, nor would I have accepted them). What we
actually got was a tsunami of alleged literature that said we should be doing
more about non-malignant pain and that addiction was a minor risk. And, well,
most of us bought it. Of course, look at who turned out to be behind it.

~~~
tastythrowaway
respectfully, what remotely well-trained doctor _didn't_ realize that part
about an opiate being only a minor addiction risk was obviously bullshit?

~~~
jmalicki
The book Dreamland[1] chronicles a lot of this history... but a belief in
science means that if scientific studies challenge some of your preexisting
beliefs, you accept that evidence.

[1] [https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidem...](https://www.amazon.com/Dreamland-True-Americas-Opiate-
Epidemic/dp/1511336404)

------
toastermoster
I'm surprised there was no mention about insurance and billing requirements,
etc.

~~~
siberianbear
Yeah, that surprised me, too.

At one time in my life, I considered becoming a doctor, and had even started
to take some of the required undergraduate coursework required to apply to
medical school (organic chemistry, biology, etc.)

I started to talk to doctors about my choice, and nearly all of them advised
me _not_ to go into medicine and often went into a long rant about dealing
with insurance companies, billing issues and being told how to practice
medicine by people with only a high school diploma at an insurance company.

I might be a doctor today if it wasn't for them. I think it was for the best:
I found electrical engineering in Silicon Valley to be interesting and highly
remunerative.

~~~
daodedickinson
Same here. My father is a veterinarian, and we have many family friends who
are doctors, and they all drove me away from going into medical practice. It
is a tragic waste, because my brain is not compatible with many jobs, but
medicine as practiced from the 90s back would have been up my bailiwick, as it
gave my father, who shares most of my neuroatypical quirks, tremendous upward
mobility.

But we are men of ethical scruples. I've dropped out of multiple grad programs
due to witnessing academic fraud committed by students and professors working
in tandem to keep money flowing into administrators who believe it is their
utmost responsibility to perform a Nietzschean transvaluation of all values
until a hauntingly extreme vices become considered virtues.

If I picked the medical profession, it would be because it would be so
motivating to me to work in a highly motivating high-stakes environment where
finding the moral thing to do is not so everloving _exhausting_.

Then have a statist regime begin to intimidate and relentlessly attempt to
suborn you into destroying the voice of your conscience and the essential
_goodness_ of the caring profession is utterly lost.

After leaving a university just a few credits shy of a degree due to learning
that university administrators have knowingly destroyed the value of their
degree by handing out 50% of their CS degrees to people the professors
consider completely incompetent, I was not tempted in the slightest when the
university attempted to bribe me with a full scholarship for their Ph.D.
program and a guaranteed tenure track teaching job.

Why the hell would I want to perpetuate the scam of a completely decadent
educational husk? I am terrified that misuse and/or ignorant design of the
internet is threatening our social health; it is destroying the quality of
people's education in return for monetary "profit". EDUCATION IS PROFIT IN
ITSELF, money is merely potential energy that may help or hinder us toward
enlightenment.

So this is why our "education" system is actually a "maleducation" system:
universities as founded were dedicated to making the best possible people, but
they are now committed to making the most possible profit.

~~~
whatshisface
Why not give us a list of universities and involved persons? The only reason
they do it is because they don't think fraud will devalue their reputation,
and if nobody finds out about it, it won't.

------
databag
Having been privy to the coarse reality of about 20 students who survived 5
years of medical school, followed by FY1, FY2, and junior positions in the
NHS, the intellectualized "best effort" mulling-over in the article couldn't
be further away from reality.

~~~
thomasfedb
As a student doctor not quite yet exposed to the true harshness of reality I
feel that this article does give some perspective into the issues that I have
grappled with so far in my training. The frustrations, the conundrums, the
uncertainty, the humanity.

------
saturdaysaint
If you detect a stealth agenda between the lines, it's not your imagination.
From wikipedia: _First Things is an ecumenical, conservative and, in some
views, neoconservative[1][2][3][4][5] religious journal aimed at "advanc[ing]
a religiously informed public philosophy for the ordering of society".[6] The
magazine, which focuses on theology, liturgy, church history, religious
history, culture, education, society and politics, is inter-denominational and
inter-religious, representing a broad intellectual tradition of Christian and
Jewish critique of contemporary society._

[https://en.wikipedia.org/wiki/First_Things](https://en.wikipedia.org/wiki/First_Things)

~~~
mikeatgl
This jumped out at me.

"Abortion was originally intended to be performed in limited circumstances
only, but now has become an inalienable right in any circumstances
whatever—into which, indeed, it is impermissible to inquire."

followed coyly a paragraph later by

"This, of course, would have the corollary that mass murder by doctors would
in theory be permissible, or even obligatory."

~~~
lliamander
I do not believe the author was trying to be coy, but you are eliding the
paragraph which gives the correct context to the latter statement:

> Moreover, though we pay lip service as a society to diversity and tolerance,
> we increasingly demand uniformity. _A recent article in the New England
> Journal of Medicine argued that doctors should not be permitted to opt out
> of performing procedures that they considered unethical on the grounds of
> con­scientious objection. Once the profession, guided by ethicists, had
> decided as a whole that something was ethically permissible, no doctor
> should be allowed to go against the consensus._ This, of course, would have
> the corollary that mass murder by doctors would in theory be permissible, or
> even obligatory. Never mind: It can’t happen here. But what was once
> unthinkable can become thinkable very quickly.

The emphasized section above shows that his point is about overriding the
moral judgement of individual doctors with legal fiat. In my mind, the risk is
not just the law will someday mandate doctors participate in mass murder.
Rather, that by eroding the judgement of doctors in the present, people who
tend to think for themselves will self-select themselves out of the profession
all together.

~~~
aidanfindlater
The actual debate among physicians is about the ethics of denying patients
care to which they have a right. There is no law or legal fiat that forces
physicians to do things they object to. We are instead held up to a standard
of care by our professional regulatory bodies, which define how a physician
should act in order to be considered a member of the profession. Most of the
rules are around ethical behaviour. With regards to conscientious objection,
our professional bodies attempt to balance a patient's right to access timely,
effective, and _legal_ treatment against the physicians right to practice
their personal ethics. How most bodies reach that balance is to say that
physicians are required to provide timely referral to another provider for any
service that they are morally objected to. For example, if you don't believe
that abortion is right, you are _not_ required to provide them (not by the
regulating body and definitely not by the law), but you also can't _prevent_
your patients from getting abortions--you need to refer them to someone who
_can_. We can't force our personal ethics on our patients. The linked article
appears to be arguing that doctors should be able to just say no, and thereby
prevent someone from accessing the care that they want.

Ultimately, the patient is the most important person in medicine, the doctor
comes second. This is not the law, this is medical ethics.

~~~
lliamander
> The actual debate among physicians is about the ethics of denying patients
> care to which they have a right. There is no law or legal fiat that forces
> physicians to do things they object to.

I agree that is the status quo. The linked article is not necessarily talking
about what the medical field currently looks like, but what it may look like
over the coming decades. The author is concerned that law may one day override
an individual doctor's conscientious objections.

I should also note that author lives and practiced in the U.K. and so if you
are writing from an American context (as I am) then it may be that the state
of medical ethics is somewhat different over there.

------
waylandsmithers
> You will no doubt hear a great deal about patient autonomy, the principle
> that the patient must be allowed to choose treatment that he wants.

This must really be tough on doctors. I have a few people in my life who love
seeking out medical advice but rarely follow it.

"You have to help me doc, I'll do anything!"

"Ok, do X"

"Well anything but that."

------
afpx
Couldn’t the negativity and cynicism of this letter be applied to most fields?

