Medicine: A Most Noble Calling

The Five P's Of A Life In Medicine

(CBS)  During an episode of Grey's Anatomy, intern Meredith Grey rattles off the five W's to consider when a patient suddenly develops a fever after surgery: wind (pneumonia), water (urinary tract infection), wound (redness and pus in the incision), wonder drug (drug-related fever), and walking (clots in the legs). Such mnemonics are fabled memory devices used by countless medical students over the ages. In that tradition, I've created a mnemonic for students applying to medical school. Before you write that first essay, consider the five P's of a life in medicine: patient, problems, practice, payment, and passion.

Patient: A good doctor can imagine what it's like to walk in a patient's shoes. A man, a woman, a child in distress turn to you. They do so not because they want to but because they need your authority, knowledge, and skill. There's no greater joy than being part of a patient's care; nothing more humbling than struggling with a disease that can't be cured. At the same time, there's no greater frustration than tending to a patient who is dismissive of your talent, ignores your advice, or is capriciously litigious. Knowledge, once locked up in medical texts, now floods the Internet and is dissected by patients all over the blogosphere. This makes for patients who can participate in their own care and communicate more effectively with physicians. But tomorrow's docs, pressured to see more patients in less time, will have to find a way to squeeze in time for casual banter and the chance for patients to discuss their broader health concerns.

Problems: Sorting out a patient's complaints, physical signs, and test results can sometimes make one feel like Sherlock Holmes. But more often, the answer is obvious to the trained eye. That eye must stay sharp, however, since medical science is forever improving therapies and changing the very look of disease. Heart patients who used to die suddenly in my early training are now living with internal defibrillators. AIDS patients whose lives were once cut all too short by overwhelming infection now live for decades on antiviral medicines. Cancer "victims" are now cancer "survivors." As the fruits of human genomics penetrate every domain of medicine, doctors will offer more effective, targeted, and personalized solutions. Medicine is a thrilling intellectual adventure, and doctors must be ever curious, for they will be, most assuredly, perpetual students.

Practice: The solo practice is going the way of the family farm, largely owing to this changing nature of medicine. Doctors need the infrastructure of hospitals or multispecialty groups to access the latest in medical equipment, information technology, and specialized talent-making practice very much of a team effort. Along with this, the stature of non-M.D. professionals grows. As nurse clinicians offer flu shots and treat sore throats, psychologists write prescriptions for psychotropic drugs, and public-health experts oversee physician performance, some doctors feel their own authorities eroding. With a projected doctor shortage and a growing elderly population, this trend will no doubt continue.

Payment: Medical training can easily leave students with debt of $120,000 or more. Salaries are good, averaging about $200,000, with specialists like surgeons-who spend more years training and tend to work longer hours-commanding more. Increasingly, doctors have less control of their ledgers, as health insurance shifts control of the medical purse to third-party payers. In turn, doctors' fees are capped and even reduced, and their offices are snowed under with paperwork and insurance approvals. But there is a trade-off. The new generation of doctors can expect less brutal hours. Even heart surgeons want to be home for dinner most nights, unthinkable in times gone by.

Passion: Whatever the challenges, the quiet passion of medicine is what inspires-passion for helping others, for new ideas, for doing good. Caring for patients and researching their ailments attract a special breed of smart, dedicated men and women. Many physicians believe in miracles, too, a testament to the soul of medicine and the mystery of human life. As you ponder this career, know that medicine is more than a job, more than a profession. Medicine is a noble calling that captures your heart. It has mine, from the very first time I was ever called "doctor."