A Personal Plea to Premeds

When I was in college, I was in a premed “bubble” a lot of the time. I took many of my courses and labs alongside hundreds of other aspiring physicians. I would see the same people throughout my academic day, and sometimes even outside of the lecture hall. Because of this, I unintentionally overheard conversations about some of my peers’ motivations to go into medicine.

“It’s a stable salary, you know? I feel like other jobs are less secure. Even after I get old, what are they going to do, fire me?”

“Yeah, but if I go into business, I can’t guarantee being rich. Like as a doc maybe I won’t be super rich. But I can guarantee a certain degree of wealth.”

“I like biology, but I can’t see myself as a teacher or researcher. So, it’s my only option.”

“My parents really want me to do it. And I guess it doesn’t sound horrible?”

I would also overhear conversations on what they perceived would make a good applicant to medical school.

“It’s like checking off boxes. Show them that you care about people by volunteering, get good grades, and shadow a doctor so you seem prepared for the field.”

“I’ve heard being a certified tech or getting an EMT license is a surefire way to be granted an interview.”

“At the interview, you just have to emphasize that you actually care about helping people. Don’t we all?!”

When I heard these comments, at first, I felt angry. It seemed like many of my peers were interested in the byproducts of pursuing a career in medicine and not the profession itself. Process of elimination or job security seemed like they were the sole motivators for earning an MD or DO. It also seemed like applying to medical school had turned into some kind of slick game—racing through a bingo board of suggestions from other students was the most efficient way to be a competitive candidate. Thankfully, admissions officers often caution applicants about taking a “check the box approach” and rely on interviews and applicant experiences to learn more about the motivations and preparations of applicants.

My frustration subsided with time as I recognized that most students often have multiple motivations for considering any career path. And the vast majority of students undoubtedly recognize the long and difficult journey that a career in medicine takes, only pursuing it if they ultimately have a passion to care for patients. Maybe what these 20-year-old premeds struggling through organic chemistry thought did not matter.

A few years ago, when my dad’s type 2 diabetes severely worsened, I had an experience that opened my eyes. His Hemoglobin A1c levels had spiked within only a few months, which piqued the concern of his primary care physician, endocrinologist, and cardiologist. Suddenly he was out of his NYC-centered 5 a.m. wake-up lifestyle and in and out of doctors’ offices. He was confused about how his diabetes had gotten out of control so quickly and afraid of how it might affect our family. He was unsure if he should be writing a will. And his fear was contagious.

Dinner conversations and daytime phone calls about news of his health transitioned into heated exchanges about the best course of action. Each physician my dad met with suggested a different lengthy list of treatment options. There was no caring conversation to address the shock of the past few weeks. No personalized suggestions or desire to follow up with him after making a choice. To me, it seemed like there was no intention to fight the disease as a team.

There was the option of taking 3 pills a day with drug A (with food). Another option consisted of taking 2 pills a day with drug B (no food). A third option was a daily insulin shot. A fourth was carb and calorie counting with adaptable dosages. A fifth option was following the exact same diet each day. My mom and I felt vulnerable and uninformed, at the mercy of the health system, and unable to advocate because of our lack of information. When we meekly brought up our uncertainty to his physicians, they asserted that this disease was really common and that my dad would need to adapt to side effects no matter which option we decided to follow. We were so afraid that we would end up making the wrong decision for my dad. It took about three different experimental medications and four diet switches before he found a schedule that allowed him to feel like himself again. Finally he could go for a bike ride with me, return to work, and resume non-medical conversations at dinner.

The physicians who interacted with my family were most definitely well-educated. They received high reviews on online physician review websites and clearly knew what they were talking about—they were able to offer dozens of solutions to a problem (one of which eventually worked in managing his diabetes). But they did not approach their patient care with care. They did not try to patiently inform a family with no prior background in managing diabetes about how to approach living with the disease. This motivation to collaborate, intention to educate, and care towards our feelings would have helped make us feel supported.

My family’s experience was not unique. Timothy Hoff, a management professor at Northeastern University, and others have asserted that medicine is becoming less empathetic, more transactional, and less focused on patient relationships. This is perhaps a downstream effect of the game-like mentality shift occurring with premeds over the last decade.

Despite what some are calling a trend in impersonal medical care, the importance of physicians approaching their patients with a primary and genuine desire to improve the human condition cannot be underscored enough. The COVID-19 pandemic has made it clear that the foundational principles of medicine are critical to uphold. Physicians caring for COVID patients have moved away from their family members to keep them safe. They have had to reuse PPE due to supply shortages, work extended hours to manage surges, and grieve every day with terminal COVID-positive patients who pass away in isolation. These are just some of the sacrifices that physicians all over the country continue to make, even outside of pandemics.

Many of my undergraduate peers’ comments implied a stereotypical and glamorized version of medicine. They implied an inherent misunderstanding of what it takes to be a compassionate physician, of how hard it can be sometimes, and of why a commitment to empathetic patient-centric care matters. This is why it is so important for premeds to engage in significant or long-term experiences in healthcare before entering medicine. It is essential that they have – to the best degree possible – a solid idea of the medical profession and the expectations they will face upon entering it.

In any hospital setting or clinical practice, there will be elderly patients. Patients with language barriers. Non-adherent patients. Disrespectful patients. Socioeconomically disadvantaged patients. Homeless patients. Scared and unsure patients. Dying patients. As providers of health care, physicians must possess the heartfelt intention to care for them all. It is okay to love a career in medicine for more reasons than one; but serving your community has to be your Why, above anything else, for becoming a physician.

Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.