Medicine is selfish

Whether you are in fact “pre-med,” are friends with a bunch of us nerds or are just a casual spectator of folks drawing organic chemistry reactions all over Link study rooms, there’s a pretty good chance you’ve asked somebody (or yourself) a question: “Why medicine?” In response, I’m betting you heard the standard answers: “to help people,” “to change the world,” etc. I know them, because I’ve recited these verbatim for the past three-and-a-half years. Yet, while the sentiment of selflessness may be genuine for some aspiring docs, I don’t buy it anymore—at least not from myself.

See, as one of many at Duke passionate about addressing health inequality, I’ve come to realize that medicine is just one of many ways to “help” the “sick.” I’ve also been trained to view the achievement of my full potential as—for better or worse—a function of the scale of impact I make. As such, if I really wanted to help people, wouldn’t limiting my ability to address the structural factors that contribute to illness (access, poverty, neglect, etc.) by, say, seeking the security and prestige of medicine be a bit selfish? It’s a question I’ve been wrestling with for some time—especially in the context of recent events.

Just a few weeks ago, the N.C. General Assembly faced a major decision to extend access to healthcare to over 500,000 citizens. Like every state, North Carolina had the option of expanding Medicaid through a provision of Obamacare that directed the federal government to subsidize health coverage for low-income citizens for a decade and beyond. Yet, even though this policy would have protected the most vulnerable North Carolinians at low cost to the state, legislators swiftly rejected the offer.

This wasn’t just a function of politics as usual. As Florida Gov. Rick Scott, a passionate conservative and one of seven Republican governors to expand Medicaid, stated, “While the federal government is committed to paying 100 percent of the cost, I cannot, in good conscience, deny Floridians that need it access to care.”

As someone contemplating spending the rest of my life on similar efforts, the reluctance to agree on the need for even the most basic change terrified me. Could I accept making no difference at the end of the day?

Recently, this calculus became a bit more personal. For the past few weeks, I’ve spent time at Project ACCESS, an organization in Durham that helps connect low-income, uninsured patients to specialist physicians while covering their charges. My job? Interview patients for an hour, ensure their eligibility and hear their stories. Soon, I realized how tough it would be to stare these patients in the eye just a few days after their elected representatives essentially denied their self-worth as people. I couldn’t really see how the 62-year-old farmer who kept tending his crops in the midst of a battle with Stage IV prostate cancer or the 45-year-old security guard who couldn’t see clearly during the night shift because of a retinal hemorrhage were somehow “parasites” of society. If their lack of personal responsibility prohibited them from access to basic medical services, then I shudder to think what I—the lazy, privileged son of two physicians who has never worked a day in his life—deserve.

At the same time, however, the instant gratification of playing some role in connecting folks to resources—to drugs, to diagnostics, to doctors—helped me cope with the powerlessness that all advocates felt from failure. In many ways, the sights, sounds and sensations of the experience gave me a taste of medicine. The swing of the door closing as a patient entered the room, transforming a sterile enclave into a safe space for vulnerability and empathy. The ruffling of paperwork used to document patient history, punctuating the impossible task of translating stories of suffering, hope, humor and despair into a series of neatly categorized checkboxes. The swell of pride one felt after being able to promise someone that you could provide help; the constant lurking fear of having to confess the opposite. Even though my efforts weren’t addressing the “root causes” of these problems, I felt a certain joy in being able to do something.

And maybe that’s why it’s okay to pursue medicine as we know it for reasons that aren’t completely selfless: because we all crave the ability to point to our own impact, to be able to say with certainty that if I didn’t exist, something would be different. There’s no denying medicine offers a very tangible skillset to create change, even if we’re mostly reacting to suffering we could have prevented through systemic changes in the first place. This desire to actualize change isn’t bad, per se—for all I know, perhaps this gratification is what keeps advocates for structural change sane during periods of adversity. My reflections have helped me realize I’m not immune to these temptations of ego, and maybe that explains why I need medicine: Because, whether I like it or not, I’m selfish, too.