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A physician’s knowledge in the service of society

On the medical school interview trail, I’ve met some amazing people. Their experiences, their values and their goals were inspiring, especially in the field of medicine. On my most recent trip, I found myself sitting at a table eating hotdogs with three other people who had all taken two gap years.

One had spent two years volunteering with Americorps. Another had spent two years working with a nonprofit that focuses on homelessness in Washington, D.C. The last one had only been doing Alzheimer’s research with the National Institute of Health.

What was I doing at the same table with these people? I felt I couldn’t possibly be worthy to share these Chicago-style hotdogs with these model citizens. They dedicated not one, but two gap years in service to a community.

Duke has taught me how to manage academic rigor and pursue scholarly inquiry, yes, but the most valuable lesson has been challenging me about how I could apply my education to the service of society. Economics? Consider microfinance in developing countries. Law? Consider working pro-bono cases in the community.

But what about medicine? You don’t have to look far to find a premed saying they are choosing medicine because they want to “help people.” Are physicians automatically using their knowledge in the service of society because they are helping people every day? I’ve had my share of interacting with non-profits, but for some reason, I didn’t view the work of physicians to be as selfless as the service of the people in the nonprofit.

To understand this issue, perhaps we can examine where people first encounter service on their path to be a physician. Premed students across the country are no strangers to service—in fact, it is almost an unofficial requirement for most medical schools. Because we have limited medical training and capabilities, we engage in non-medical service. This exposes us to a variety of social issues such as education, poverty, or racial inequalities.

What’s troubling is that the rates of engaging in non-medical service decline the further these students progress into the profession. According to a recent study, 76% of medical students regularly volunteer during medical school and 84% anticipate doing so as well in their future practice. But the rates of service drop precipitously in residency and another study says only 39% of physicians have volunteered in the past 12 months, and 54% in the previous three years.

There are several possible explanations for this. Obviously, people become busier, which easily explains the sharp drop during residency. There are also extra pressures and increasing disillusionment as people age, which may not affect students in college as much. But with how busy doctors are every day with treating patients, isn’t the very act of seeing patients considered service to society?

On one hand, there are absolutely brilliant doctors performing mind-boggling procedures or discovering new techniques with high efficiency. Perhaps it could be argued that any time spent on anything other than their work would be a disservice to society. Place such a doctor in a community, and the health of the community would definitely improve.

But don’t physicians need to do more to be classified as using their knowledge in the service of society? Otherwise such a definition would become too easy to qualify. Are firefighters inherently serving their community? Probably. Are restaurants inherently serving their community? Literally yes, but probably not.

The problem comes when physicians focused only on their practice end up caring only about someone when they enter the hospital walls. After all, there are so many factors affecting health, it seems so narrow-minded to only care about a person’s clinical health. To truly serve society, a physician needs to work for so much more.

At the same time, facing the world’s problems is daunting. It becomes nearly absurd for one person to try to address the violence and poverty that cause health problems. Physicians typically are not short of empathy to give, but they choose to limit what they care about to not become burnt out.

I know of fantastic physicians who have a tremendous positive impact on society with their practice alone. But I also know of equally fantastic physicians who find time to engage in nonmedical service to their community. Is the work of the first type of physician enough, or do they have a responsibility to do something more?

"Am I truly using my knowledge in the service of society?" is a question I can barely answer for my future career, let alone anyone else’s career. However, the very act of asking this question helps guide our actions. Those people I met over hotdogs were brave enough to take a major step into discovering what that question meant for them. Whatever profession we choose, we shouldn’t just ask ourselves if our society is better off because of us, but if we are actually fulfilling our responsibility to society with our knowledge.

James Tian is a Trinity senior. His column runs every other semester.

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