Tuesday, April 03, 2018

Brain Drain: Doctors

In my era, it was considered the pinnacle of academic success to go to med school.  Law school was slightly behind, but essentially equivalent.  People who went to graduate school in hard sciences, as many of my friends did, went because they loved their field, were intrigued by it. They hoped - especially the engineering and computer types - that they might become prosperous thereby, but it was the fascination, or perhaps the joy of being good at something, that drove them. It was similar among my friends who went for advanced degrees in humanities or social sciences. The MBA was an exception.  That was for people who had loved history or economics or German as undergrads, but were now buckling down to make serious career money.

That was true of the generation before mine as well.  There is an interesting event in Asimov's autobiography In Memory Yet Green of him addressing a group of medical students. He had a PhD in chemistry, but one of the questions was clearly meant to sort out whether he was a "real doctor" (snigger). That's the way people viewed it then. I don't think that would be true now.  I don't know, and I don't know when the change occurred. Yet the testimony of literature and everyday conversation supports the idea that the best and brightest became medical doctors throughout the 20th C. If you hated blood you could excuse your way out, and women were at first pressured away from med school, then pressured into it, inflection point somewhere in the 60's.

Yet - consider that doctors killed more than they saved until about 1940, penicillin being the big boost. The germ theory became established, gradually but long before that, so basic sanitation and quarantine were understood. Anesthesia and aspirin had come along, X-rays could tell you whether and how a bone needed to be set, yet by 1935 the smartest people - or at any rate those who had the reputation in every town of being the smartest - were still killing more people than they saved. Babe Ruth made more than the president in 1930 and joked "I had a better year." He had a better year, in the sense of providing useful service, than most doctors that year, too.  As did most of the rest of the major leagues.

Part of this may have come from the medical profession's insistence on making its smart practitioners stupid by training them during sleeplessness (while working in hospitals, where the sickest patients are, and killing them), then insisting that they have at least some hours of stupidity by being on call throughout their careers. Yet all of our parents and grandparents conspired in this, to grant the highest status and often wealth to those who didn't actually do much good.

We should be grateful that as many people as did decided that they really loved computer programming or geology, deciding that med school could go hang. Yet I wonder if we didn't waste a good deal of American brainpower by culturally rewarding medicine over other fields. (I believe many others have already made the same observation about law school.  I don't feel qualified to answer that.)

I have always thought Allen Ginsberg's most famous quote to be incomprehensible and foolish.  But if you slip in the word "medicine" for "madness," with an eye to the many night shifts that residents do, it begins to approach sense.
“I saw the best minds of my generation destroyed by medicine, starving hysterical naked, dragging themselves through the negro streets at dawn looking for an angry fix angelheaded hipsters burning for the ancient heavenly connection to the starry dynamo in the machinery of the night.”


Donna B. said...

Medicine has not progressed evenly. That's partially due to specialization, accompanied by quackery and pseudoscience.

Pediatrics is hampered by anti-vaccine and other crap. Family medicine and internal medicine is hampered by chiropractic, homeopathic, & naturopathic crapola. Surgery and anesthesia fare better, I think... though anesthesia is hampered by the "pain" and "opioid" BS. Neurology and psychiatric medicine are screwed IMHO because pseudoscience is rampant in those fields. And it's rampant because the actual science is somewhat unsettled.

Medicine is rough and tough. I'm sure lawyers will say the same, but the magnitude feels different to me. "Pure" computer scientists have it easy -- zeros and ones -- but data analysts? They are future bogeymen.

Assistant Village Idiot said...

They can actually do some good these days, though, and that's something. In 1918, what could a doctor do for you? Set a bone. Tell you that your heart was good enough to join the army. Diagnose what you were probably dying of. There were a few things that worked sometimes for constipation or diarrhea, for dry skin or oozing skin. Send the daughter away to her grandmother's farm for the summer at 13 with "greensickness," for the good of everyone. Not much.

james said...

"Marcus the doctor called yesterday on the marble Zeus; though marble, and though Zeus, his funeral is to-day."

james said...

I suppose when you feel that you have to trust someone, you're more likely to want to believe they're the best. I've noticed that lots of people are dubious about the schools, but tend to think highly of their kid's teacher.

And there's sampling bias too--the ones that weren't cured don't testify as often.

Sam L. said...

I recall reading, years ago, that Azimov did not become a medical doctor because of the blood involved.
I've had heart surgery. When I recovered from the anesthesia, I hurt, but less than I'd expected. Was released 5 days later. Was pain-free the following day.

Donna B. said...

Is there an equivalent to quackery in the legal field? Ambulance chasers? Class action lawyers? Prosecutors that resort to the tactics of ambulance chasers and class action lawyers?

It's difficult to compare the two fields.

RichardJohnson said...

One consequence of the best students going into medicine was that a lot of those best students ended up in medical research. We know a lot more medicine than we did 100 years ago, as a result of that research. Result: physicians who can actually help their patients.

gcochran said...

I taught premeds: on the whole they weren't the best students. Nor are they today.

Physics and math majors are