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Medical School, Medicine, Undergraduate

Medicine’s Dilemma of Delivery

My decision to pursue a career in medicine required that I first resolve the current “dilemma of delivery”, that is, medicine’s failure to uniformly provide health services in ways consistent with its two central imperatives: do no harm, and help those in need. Though I believe most medical practitioners strive to observe these maxims, the data show that organized medicine in the United States – with its fee-for-service model and systemic vulnerability to the competing influences of the pharmaceutical, insurance, litigative, HMO, and for-profit care industries – sometimes violates both. But it also, at its best, fulfills both, and often in dramatic fashion. Unfortunately, which outcome occurs in any given case is, far too often, influenced by the patient’s socioeconomic status and ability to pay.

Universal health care

Distribution of universal health care coverage; Image via Wikipedia

I believe in the right to health care, so the decision to participate in a system that insufficiently and inconsistently protects that right – that forces some to choose between needed care and financial ruin and leaves others without even that choice – was, for me, a difficult one. In deliberation, I was reminded that while all endeavors naturally inherit our human imperfections, they can also benefit from our determined, concerted efforts to improve their outcomes. I have observed firsthand, in the clinic and operating room, the awesome, fundamental good routinely delivered to patients in need, and it is something I deeply want to contribute to. The process of making the delivery of that good more humane, accessible, and efficient is, at least in part, dependent on the abilities of we physicians-in-training to see medicine for what it is now, and what it could be, with our vision and hard work, in the future.

But there were other important, complex considerations, both professional and personal, influencing this pivotal decision to become a physician. Throughout the process, whether while wrestling with the “dilemma of delivery”, or assessing my suitability for the medical profession, or appraising the financial consequences of medical school debt, my wife played a central and invaluable collaborative role. We share strong commitments to human development issues, especially health, and have for many years planned a professional partnership in global health work. So when medicine began to emerge as a significant component of my interests, neither of us was immediately warm to the idea. Our earliest conversations focused on the negatives: too broken a system to work in; too much time in training; too much debt. But eventually, medicine’s humanistic mission and unique cluster of qualities took root in my imagination and, subsequently, prominence in our discussions.

The Doctor, by Sir Luke Fildes (1891)

The Doctor, by Sir Luke Fildes, (1891); Image via Wikipedia

Over time, those initial objections diminished or resolved. As a last act of waning resistance, and in hope of steering this growing zeal in a direction less demanding of sacrifice from me and my family, I investigated and considered several other health-related professions and pathways. It became clear to me, my partner, and my mentors, however, that my professional goals and personal strengths will be best realized as a Doctor of Medicine. It’s become equally clear to my family that the sacrifices necessary for success during this long-term endeavor are acceptable and sustainable for the duration without threat to our health and happiness. At peace with the decision and resolute, we’ve become eager for the adventure and excited by the possibilities ahead.



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