My great grandfather graduated from the University of Louisville Medical School in 1901. My grandfather would have followed suit, but for the Great Depression. My father finished his MD at the University of Louisville in 1961, and my turn came at the University of Oregon Medical School in 1981.
I think I can say a few things about medicine. First, it’s never been easy to be a doctor taking care of real people. My great grandfather set up practice in Appalachia, far from any urban center, and using ether and the most crude of instruments, set about bringing the beginnings of the surgical era to backwoods Kentucky. He carried a pistol to defend himself from angry family members if things got out of hand.
Second, the rate of change induced by scientific discovery, is far from slowing, and in fact, seems to be accelerating. My father’s career in particular, spanning the era of specialization, witnessed the fruits of research from the National Institutes of Health in the first decades after World War 2. Broad scientific developments drove the discovery of hundreds of new medicines and the specialists who could understand and prescribe them. Lifespans have lengthened so fast as a result that we have become numb to the amazing demographic shifts happening before our eyes. In 1950, America was home to 2300 people 100 years or older. In 2050, a bare century later, America will shelter up to 4.2 million of that age, a rise of 180,000%!
Third, charlatans and con artists have always been a part of the tapestry of medicine. They are drawn partly to the money, but also to the great need. Patients and families can in their moments of desperation part with normal vigilance and good sense, embracing hopeless ideas through sheer will and magical thinking. It is never easy to speak truth with hope, and I doubt we will ever have a surplus of physicians able to care compassionately for all those who are truly ill.
Finally, we are fully engaged in a new Great Age of Medicine, that of systemization. All of the knowledge of science, still moving rapidly forward, is being melded with the skills of information management and the operational strengths of highly reliable systems. Wise implementation of health delivery will proceed in ways that support rather than demean the human elements of the enterprise, but such effective restructuring will require diligent supervision and awareness. A great system of health care delivery will not happen by accident.
I see no reason to be glum about the prospect of a career as a doctor. Quite to the contrary, I do not think the future has ever been brighter for our calling, though the work will remain challenging and every day will bring almost as many disappointments as successes. When one is tired or feeling pressed upon by circumstance, it helps to take a step back and marvel at the longer view and the wonder of what is really engaged in the task at hand.
