5 ms·

Ironically, med schools are taking the opposite tack. Because reading books and watching TV shows about medicine are so wildly divorced from the real thing, and

Ironically, med schools are taking the opposite tack. Because reading books and watching TV shows about medicine are so wildly divorced from the real thing, and because so many kids are really launched towards medicine by their parents, "I always wanted to be a doctor" is considered a (mild) red flag: it's an indicator that someone is pursuing the field based on childish fantasies rather than a rational, adult decision. The former tends to create more failures and burnouts, which med schools try to avoid if for no other reason than because drop-outs are lost tuition. As a doc: you can't become a doc for love of the profession, because it's a profession you can't test drive. You can become a doc for love of the fantasy of the profession. It's awesome that programming is different in that way: you can't produce an OS in HS, probably, but you can certainly take a run at making simple stuff in python or simple iphone games.

luckydata 8y ago
You can absolutely become a doctor for the love of taking care of people that are sick and help them overcome a bad situation. Many of my friends displayed a caring side very early on (middle school).
- arkades 8y ago
  > become a doctor for the love of taking care of people that are sick and help them overcome a bad situation That’s the fantasy. And, hey, when it pops up, awesome - it’s a very energizing moment. However, most medicine has absolutely nothing to do with that day to day. The day to day is subject to Pareto’s Law. A surgeon may occasionally get to “take care of the sick,” but 80% of the time they get to do a five minute chart review of an obvious gallbladder passed along from the ED, a cookie cutter GB removal, and an uneventful recovery that involves a daily stomach poke and the same handful of questions they ask every other post-op pt on the floor. Medicine is a technical profession.
  - kamaal 8y ago
    One likely won't get that good at surgery unless they practiced a lot. And if they had no interest towards that profession they likely won't be putting in crazy hours in their prime early career time becoming a surgeon. You can't even become good at flipping burgers without being interested in doing it.
    - vonmoltke 8y ago
      "Interest" is not "love" or "passion". Anyone using the latter terms as synonyms for the former is seriously diluting their meaning.
  - luckydata 8y ago
    You're talking about the bad ones, the ones I hate to see. The friends I'm talking about are all excellent professionals. Passion matters.
    - lovich 8y ago
      You can't be passionate about boring work 24/7 and most jobs are boring work. Even if they aren't when you start, once you've done something 1000 times it becomes rote. Why do you think there's stories of burnout from places like google where people join up to do great work, but get stuck doing CRUD apps to support the business? The only people I see claiming everyone needs to be passionate all the time are business owners and management who then channel that passion into unpaid overtime
    - arkades 8y ago
      No, I'm talking about 99% of docs 99% of the time. It's a job. It's a great job sometimes, but it's paperwork most of the time. For every hour we spend rounding in the morning - when we're given at best 2/3 of the time we need to actually do the bare minimum, and half the time we need to really talk to people - we spend another 1-2 hours (minimum) in a windowless room doing a pile of paperwork notating the hell out of the morning's visits. I won't mention the X additional hours doing bullshit like wrangling with insurance companies and home healthcare and calling the nurse to very-politely-because-we're-all-a-team-here find out why my STAT EKG on last night's chest pain didn't get a fucking EKG. No one is passionate about paperwork in windowless rooms and workplace political wrangling. No one. But that's what it is most of the time, because it's a job. A real world job, with TPS reports (heh) and never enough printer paper to go around. But, hey, if you want to buy the hype, go for it.
      - mjevans 8y ago
        Would being a doctor be better in a system where there was /only/ a choice of either single payer or bring your own all-cash payment? (No 'insurance' at all.)
        arkades 8y ago
  - carpo 8y ago
    Im confused. All those small day to day technical things you described are opportunities to help and care about sick people. On the otherside of the chart is someone in pain. Its maybe not House, but it will make a huge difference in their life. If I was hiring a doctor, I'd want the person that understood that.
    - arkades 8y ago
      Picture a lab. It's a Nobel laureate's lab. They work on biochemistry. They work on producing drugs that might one day cure cancer. Everyone that works there gets to say, "all the small, day to day, technical things I do ... are opportunities to help advance the fight against cancer!" And it's plausible! They're rockstars! The primary investigator, he still has to chair like six goddamned committees because that's the institutional politics of his job. But it lets him do his job, so it gives him a chance to cure cancer! Surely that somehow makes all those committees less tiresome and boring. Every time someone spends half an hour arguing the merits of switching what brand of coffee pod they want in the faculty lounge (read: closet), he can think to himself, I'm doing this to cure cancer! Certainly that makes all the boredom just zip and go away. His senior PhD student? When he's up at three AM writing a last-second response to a peer review of his latest publication of a boring and predictable iteration of their last study (but needed, to juice his pub count and help him land a job FIGHTING CANCER!)... when that response makes it abundantly clear the reviewer didn't bother reading his damn paper and just wants the student to revise it to cite the reviewer's last paper (to juice their pub count)... well, that student can rub the grit out of his eyes, pour himself another cup of discount-brand pod-coffee, and say, this is awesome! I'm helping to fight cancer! When the janitor comes in in the morning, and gets pissed because the water has turned blacker than the faculty's discount coffee but the nearest closet with a hose is on the other side of the goddamn building, well... hey, that's okay. Because he's keeping this lab clean, which helps the lab workers do their jobs, which means he's helping FIGHT CANCER! None of that is un-true. All of that helps people get out of bed in the morning. But just because your job, big picture, has a noble end doesn't mean the every-day misery of every-day work is somehow magically awesome. If I was hiring a doctor, I'd want the person to understand that. Because if they didn't, they'd be a goddamn train wreck once they found out that hours of paperwork hoop-jumping isn't any more exciting just because it's medically related. I don't mean to go ad-hominem here, but honestly: are you a college student or something? If you've held down a job, you should fully understand that the "mission" of the job is separate from the day-to-day tedium of ... work. Work is work.
  - samontar 8y ago
    My parents are surgeons and considering all the stories they’d tell me growing up about the conditions they treat and the surgeries they perform I’ve got to say it always sounded like what you describe as the fantasy. They still enjoy it in their 60s. Boredom has never been an enemy they’ve faced. And I’ve thought about it and over the last decade of programming I get it. Boredom hasn’t been an enemy I’ve met. And I look around at my friends and nor is it an enemy they know. I think the cynicism just misses the joy most people get from performing their craft right.
    - arkades 8y ago
      Of course they don't discuss the boring routine. When I get home, I talk about the highlight of the day/week, too - no one talks about the ubiquitous routine. But it's a job, not an episode of ER - most of it is the ubiquitous routine of jobs everywhere.
      - samontar 8y ago
        Yeah, but that routine isn’t really boring, is it? My job is arguably less exciting and I don’t find it boring.
plurgid 8y ago
> you can't become a doc for love of the profession, because it's a profession you can't test drive oh, I don't know about that. It's like a 6 week community college course to become an EMT. There's a test drive for you. There are 2 year programs that will get you a nursing license. You can get a taste of the medical career path without going the full MD route. Maybe not as accessible as coding, but it is accessible. As my kids are just now graduating HS, this is something I try to drill into them. College can be like an assembly line that spits you out saddled with the equivalent of a 30 year mortgage, trained for a job space that you literally have no idea if you'll even want to do ... or it can be like a Baskin Robins of careers, and you can try every last one of them until you find what you really like. passion and knowledge of self are everything. the rest is a commodity.
- arkades 8y ago
  > It's like a 6 week community college course to become an EMT. There's a test drive for you. There are 2 year programs that will get you a nursing license. EMT and nurse aren’t “mini doctors,” any more than doing video game QA is “mini programming.” It gets you near the profession, it doesn’t put you into the shoes. I don’t know how to articulate this. The job that requires about eight years of post-grad training, including four of them as heavily supervised on-the-job training with slowly increasing responsibilities for 80-100 hrs/week, is wildly different than the job that you can start doing in six weeks. Working in the same setting as a physician is no more “test driving” what it’s like to be a doc than being a secretary at a hedge fund is test driving what it’s like to be a hedge fund manager.
  - sizzle 8y ago
    What about shadowing a doctor in high school? You literally follow them around all day and get a taste of what they do.
    - arkades 8y ago
      The thing is, the salient bits of being a doctor have to do with the thought process going on in their head, the stresses of responsibility and decision-making, and all the considerations they weigh with each patient. It's just not an "observable" thing. Docs don't really start sharing their internal processes with you until you're in the second half of med school, and even then not commonly. From the outside, it just looks like... guy in a white coat, often at a computer, making pronouncements. And then doing paperwork, which largely consists of documentation to prove to the government and insurers you did everything they decided should have been done for that patient and if not, why not. The combination of accountability and lack of autonomy is a leading cause of physician burnout and, again, is all internal. The other part it leaves out is the hours. "What do I do with this patient?" is a very different thought process at hours one, eleven, and eighteen respectively, of what should have been a twelve hour shift. One hospital I know of has its trauma/SICU surgeons do 5 days on and 5 days off where they pull 12 hour shifts daily, and they're on call every night. But trauma/SICU doesn't really sleep, so these folks are making critical care decisions at hour one-hundred-and-twenty, of which maybe eight hours involved sleep. All of these things occur in the internal landscape. Shadowing is ... not effective. Most med students have done clinical research, shadowed doctors, volunteered in hospitals, etc. Back in the day, I did hospital volunteerism, clinical research, hospital QI, and I worked in health insurance. I'd seen medicine from pretty much every vantage point before I second-careered into being a physician. And every senior med student and resident and physician will tell you, "holy shit, I had absolutely no idea what it would be like." Even the occasional nurse that decides to go to med school, who most commonly think they're halfway to being docs already, will say "omg, I had no idea how much I didn't know, and how much you guys have to do." We had two in my med school class back in the day. When we were in didactics, they were shocked by how much docs had to know. When we got to clerkships (the second half of med school, where you work in hospitals) they were floored by how much was involved in being a physician that simply wasn't visible to nurses. And that's... you know, nurses. Folks who work in our vicinity on a daily basis.

luckydata 8y ago

You can absolutely become a doctor for the love of taking care of people that are sick and help them overcome a bad situation. Many of my friends displayed a caring side very early on (middle school).

arkades 8y ago
> become a doctor for the love of taking care of people that are sick and help them overcome a bad situation That’s the fantasy. And, hey, when it pops up, awesome - it’s a very energizing moment. However, most medicine has absolutely nothing to do with that day to day. The day to day is subject to Pareto’s Law. A surgeon may occasionally get to “take care of the sick,” but 80% of the time they get to do a five minute chart review of an obvious gallbladder passed along from the ED, a cookie cutter GB removal, and an uneventful recovery that involves a daily stomach poke and the same handful of questions they ask every other post-op pt on the floor. Medicine is a technical profession.
- kamaal 8y ago
  One likely won't get that good at surgery unless they practiced a lot. And if they had no interest towards that profession they likely won't be putting in crazy hours in their prime early career time becoming a surgeon. You can't even become good at flipping burgers without being interested in doing it.
  - vonmoltke 8y ago
    "Interest" is not "love" or "passion". Anyone using the latter terms as synonyms for the former is seriously diluting their meaning.
- luckydata 8y ago
  You're talking about the bad ones, the ones I hate to see. The friends I'm talking about are all excellent professionals. Passion matters.
  - lovich 8y ago
    You can't be passionate about boring work 24/7 and most jobs are boring work. Even if they aren't when you start, once you've done something 1000 times it becomes rote. Why do you think there's stories of burnout from places like google where people join up to do great work, but get stuck doing CRUD apps to support the business? The only people I see claiming everyone needs to be passionate all the time are business owners and management who then channel that passion into unpaid overtime
  - arkades 8y ago
    No, I'm talking about 99% of docs 99% of the time. It's a job. It's a great job sometimes, but it's paperwork most of the time. For every hour we spend rounding in the morning - when we're given at best 2/3 of the time we need to actually do the bare minimum, and half the time we need to really talk to people - we spend another 1-2 hours (minimum) in a windowless room doing a pile of paperwork notating the hell out of the morning's visits. I won't mention the X additional hours doing bullshit like wrangling with insurance companies and home healthcare and calling the nurse to very-politely-because-we're-all-a-team-here find out why my STAT EKG on last night's chest pain didn't get a fucking EKG. No one is passionate about paperwork in windowless rooms and workplace political wrangling. No one. But that's what it is most of the time, because it's a job. A real world job, with TPS reports (heh) and never enough printer paper to go around. But, hey, if you want to buy the hype, go for it.
    - mjevans 8y ago
      Would being a doctor be better in a system where there was /only/ a choice of either single payer or bring your own all-cash payment? (No 'insurance' at all.)
      - arkades 8y ago
- carpo 8y ago
  Im confused. All those small day to day technical things you described are opportunities to help and care about sick people. On the otherside of the chart is someone in pain. Its maybe not House, but it will make a huge difference in their life. If I was hiring a doctor, I'd want the person that understood that.
  - arkades 8y ago
    Picture a lab. It's a Nobel laureate's lab. They work on biochemistry. They work on producing drugs that might one day cure cancer. Everyone that works there gets to say, "all the small, day to day, technical things I do ... are opportunities to help advance the fight against cancer!" And it's plausible! They're rockstars! The primary investigator, he still has to chair like six goddamned committees because that's the institutional politics of his job. But it lets him do his job, so it gives him a chance to cure cancer! Surely that somehow makes all those committees less tiresome and boring. Every time someone spends half an hour arguing the merits of switching what brand of coffee pod they want in the faculty lounge (read: closet), he can think to himself, I'm doing this to cure cancer! Certainly that makes all the boredom just zip and go away. His senior PhD student? When he's up at three AM writing a last-second response to a peer review of his latest publication of a boring and predictable iteration of their last study (but needed, to juice his pub count and help him land a job FIGHTING CANCER!)... when that response makes it abundantly clear the reviewer didn't bother reading his damn paper and just wants the student to revise it to cite the reviewer's last paper (to juice their pub count)... well, that student can rub the grit out of his eyes, pour himself another cup of discount-brand pod-coffee, and say, this is awesome! I'm helping to fight cancer! When the janitor comes in in the morning, and gets pissed because the water has turned blacker than the faculty's discount coffee but the nearest closet with a hose is on the other side of the goddamn building, well... hey, that's okay. Because he's keeping this lab clean, which helps the lab workers do their jobs, which means he's helping FIGHT CANCER! None of that is un-true. All of that helps people get out of bed in the morning. But just because your job, big picture, has a noble end doesn't mean the every-day misery of every-day work is somehow magically awesome. If I was hiring a doctor, I'd want the person to understand that. Because if they didn't, they'd be a goddamn train wreck once they found out that hours of paperwork hoop-jumping isn't any more exciting just because it's medically related. I don't mean to go ad-hominem here, but honestly: are you a college student or something? If you've held down a job, you should fully understand that the "mission" of the job is separate from the day-to-day tedium of ... work. Work is work.
- samontar 8y ago
  My parents are surgeons and considering all the stories they’d tell me growing up about the conditions they treat and the surgeries they perform I’ve got to say it always sounded like what you describe as the fantasy. They still enjoy it in their 60s. Boredom has never been an enemy they’ve faced. And I’ve thought about it and over the last decade of programming I get it. Boredom hasn’t been an enemy I’ve met. And I look around at my friends and nor is it an enemy they know. I think the cynicism just misses the joy most people get from performing their craft right.
  - arkades 8y ago
    Of course they don't discuss the boring routine. When I get home, I talk about the highlight of the day/week, too - no one talks about the ubiquitous routine. But it's a job, not an episode of ER - most of it is the ubiquitous routine of jobs everywhere.
    - samontar 8y ago
      Yeah, but that routine isn’t really boring, is it? My job is arguably less exciting and I don’t find it boring.

plurgid 8y ago

> you can't become a doc for love of the profession, because it's a profession you can't test drive oh, I don't know about that. It's like a 6 week community college course to become an EMT. There's a test drive for you. There are 2 year programs that will get you a nursing license. You can get a taste of the medical career path without going the full MD route. Maybe not as accessible as coding, but it is accessible. As my kids are just now graduating HS, this is something I try to drill into them. College can be like an assembly line that spits you out saddled with the equivalent of a 30 year mortgage, trained for a job space that you literally have no idea if you'll even want to do ... or it can be like a Baskin Robins of careers, and you can try every last one of them until you find what you really like. passion and knowledge of self are everything. the rest is a commodity.

arkades 8y ago
> It's like a 6 week community college course to become an EMT. There's a test drive for you. There are 2 year programs that will get you a nursing license. EMT and nurse aren’t “mini doctors,” any more than doing video game QA is “mini programming.” It gets you near the profession, it doesn’t put you into the shoes. I don’t know how to articulate this. The job that requires about eight years of post-grad training, including four of them as heavily supervised on-the-job training with slowly increasing responsibilities for 80-100 hrs/week, is wildly different than the job that you can start doing in six weeks. Working in the same setting as a physician is no more “test driving” what it’s like to be a doc than being a secretary at a hedge fund is test driving what it’s like to be a hedge fund manager.
- sizzle 8y ago
  What about shadowing a doctor in high school? You literally follow them around all day and get a taste of what they do.
  - arkades 8y ago
    The thing is, the salient bits of being a doctor have to do with the thought process going on in their head, the stresses of responsibility and decision-making, and all the considerations they weigh with each patient. It's just not an "observable" thing. Docs don't really start sharing their internal processes with you until you're in the second half of med school, and even then not commonly. From the outside, it just looks like... guy in a white coat, often at a computer, making pronouncements. And then doing paperwork, which largely consists of documentation to prove to the government and insurers you did everything they decided should have been done for that patient and if not, why not. The combination of accountability and lack of autonomy is a leading cause of physician burnout and, again, is all internal. The other part it leaves out is the hours. "What do I do with this patient?" is a very different thought process at hours one, eleven, and eighteen respectively, of what should have been a twelve hour shift. One hospital I know of has its trauma/SICU surgeons do 5 days on and 5 days off where they pull 12 hour shifts daily, and they're on call every night. But trauma/SICU doesn't really sleep, so these folks are making critical care decisions at hour one-hundred-and-twenty, of which maybe eight hours involved sleep. All of these things occur in the internal landscape. Shadowing is ... not effective. Most med students have done clinical research, shadowed doctors, volunteered in hospitals, etc. Back in the day, I did hospital volunteerism, clinical research, hospital QI, and I worked in health insurance. I'd seen medicine from pretty much every vantage point before I second-careered into being a physician. And every senior med student and resident and physician will tell you, "holy shit, I had absolutely no idea what it would be like." Even the occasional nurse that decides to go to med school, who most commonly think they're halfway to being docs already, will say "omg, I had no idea how much I didn't know, and how much you guys have to do." We had two in my med school class back in the day. When we were in didactics, they were shocked by how much docs had to know. When we got to clerkships (the second half of med school, where you work in hospitals) they were floored by how much was involved in being a physician that simply wasn't visible to nurses. And that's... you know, nurses. Folks who work in our vicinity on a daily basis.