A few days ago, I came across the application I wrote to gain entry into my university's bachelor’s degree program. One of the questions asked about my top three career choices, and at the very top I had listed: “Doctors Without Borders.” Now, almost four years after writing this application, the potential for my dream to become a reality is imminent. The discovery of this forgotten piece of my past prompted me to reflect on what becoming a doctor meant to me, and more specifically on my ideals as an aspiring physician. Had they changed? More importantly, had I changed?
These first few months of my medical education have exposed me to people and circumstances that will undoubtedly shape my future practice. I have been particularly humbled by medical professionals who have demonstrated exemplary humanism in practice, evidenced by their stories of patient interactions and their handling of situations that are still unthinkable to me. These individuals embody the demeanor and professionalism I believe to be central to the medical profession and to my idea of what it should mean to be a physician: they are experienced yet modest, they prioritize the patient and their family, and they are unafraid to recognize fault and accept responsibility with grace, all with an eye to bettering themselves in the future. Their values are clear to me, as is their palpable conviction that only humanism can give rise to professionalism.
Consequently, the majority of my experiences thus far have been positively affirming: I often leave conversations with my seniors feeling assured that, in the busy day to day of any medical practice, there is an important place for humanistic, quality interaction between the physician and patient, in which the physician both influences and integrates themselves into the patient’s narrative. These experiences have been reinforced through case simulations that have challenged my peers and I to explore what providing quality care can look like in the face of increasing pressure to economize our time. Yet, I know that equally ingrained in my memory are the instances where I’ve called into question the pragmatism of practicing “humanistic” medicine, instances in which supervisors acted in ways contrary to both my own values and the principles medical students are taught to internalize. In one instance, what I thought was a caring, thorough, and mutually rewarding therapeutic interaction was later described to me by the attending physician as “rightfully rare,” owing to the need to balance providing quality care with attending to an ever-growing list of patients. On another occasion, the attending physician ignored a patient’s request while they explained, at length, the details of the case to present students. In both instances, I could stretch my imagination to understand the primacy of the physician’s priorities. Time was limited, and they were tasked with educating a roster of students with differing capabilities, on top of their fiduciary duties. I could almost see their thought processes—from which group could I save the most time? These observations forced me to confront the uncomfortable truth: that time is a scarce resource, and allocating it any which way inevitably involves a zero-sum game. This is a concept that I know I will grapple with moving forward, and one that I’m unsure even the most experienced staff physicians have successfully learned to navigate. In light of these experiences, I’m also forced to wonder about the extent to which time and experience can disillusion even the most humanistic of emerging physicians, and whether my own outlook will change over the years ahead. I am truly uncertain as to how I might maintain my integrity as a future physician in the face of mounting bureaucratic and fiduciary pressures.
Although I’m yet unsure as to how this tension will unfold, I am comforted by the critical lens through which, as medical students, we are encouraged to view all components of practicing medicine. I am aware that our practice is far from perfect, that spending “too much time” with one patient may turn out to be a double-edged sword, that the profession is fast-paced and ever changing. But that in spite of all this, we are expected and (dare I say it?) have the honour of caring for and speaking on behalf of those who are vulnerable, perhaps marginalized, perhaps ignored. And it is a responsibility that I hope I remember each day that I practice, because what I do know is that I should let my own values guide me for as long as possible—they form the unshakeable foundation upon which I can continue to build my understanding of what it means to be both a humanistic and professional physician.