The Yale Guide to Careers in Medicine and the Health Professions: Pathways to Medicine in the 21st Century

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Overview

Can I become a doctor? Should I? How can I find out? What is it like to be in medical school? What other careers in the health field might be right for me? What are the satisfactions and pitfalls of a career in medicine?

For anyone pondering a career in medicine or a related health profession, this book is an invaluable guide. It contains the firsthand advice of men and women working in the health field today. These diverse professionals describe how and why they made their career choices and what the journey has been like. They tell their stories with candor and humor, sharing their personal circumstances, experiences, uncertainties, and triumphs.

More than seventy medical and health professionals, including physicians, biomedical researchers, nurses, chiropractors, medical sociologists, and others, contribute to the volume. They represent many individual viewpoints and speak from different stages of their careers. The distilled wisdom of this group conveys more comprehensively and openly than ever before what it means to choose a career in medicine.

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Editorial Reviews

Doody's Review Service
Reviewer: Barbara S Beckman, PhD (Tulane University School of Medicine)
Description: This is a first person guide to careers in medicine and the health professions that all premedical advisors should have. Excellent advice is provided on contemplating a career in medicine, preparing for medical school, training to become a doctor, professing medicine, practicing medicine, and practicing in the health professions as well as conducting biomedical research, becoming a physician-executive, and thinking about medical writing.
Purpose: The book's express purpose is to address as many questions as possible for those contemplating a career in the health professions. These are worthy objectives in light of the lengthy training in healthcare careers, and the book provides exceptional first person accounts of all the important facets of medicine.
Audience: All of the contributors have worked at Yale and convey their experiences as premedical and medical students, residents, faculty, researchers, or administrators. The authors are credible and provide practical information.
Features: The book covers experiences of students in the humanities as well as in the sciences who are considering a career in medicine. Preparing for medical school is a well done section. All aspects of training are covered including practicing specialties such as surgery, pediatrics, obstetrics and gynecology, psychiatry, imaging, pathology, and genetics. In addition, health professions such as nursing, mental health, and midwifery are included.
Assessment: This is a valuable handbook for premedical advisors to have on their bookshelves. It provides more practical guidance for careers in the health sciences than I have seen in other books, and is fun to read as well.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780300100297
  • Publisher: Yale University Press
  • Publication date: 3/10/2003
  • Series: The Institution for Social and Policy St
  • Edition description: New Edition
  • Pages: 490
  • Product dimensions: 6.00 (w) x 9.00 (h) x 1.09 (d)

Read an Excerpt

THE YALE GUIDE to Careers in Medicine & the Health Professions

Pathways to Medicine in the Twenty-First Century

Yale University Press

Copyright © 2003 Yale University/Institution for Social & Policy Studies
All right reserved.

ISBN: 0-300-09542-2


Chapter One

BJORN HERMAN

A History Major Why I Wish to Attend Medical School

I decided to go to medical school perhaps five different times while in high school and college, but I don't think that any one of those decisions was critical until my junior year in college. So, from my experience, medical school is something to keep in mind early on but not something to worry about too soon if you're uncertain. I am so enthusiastic now about going to medical school because I did not limit myself in college, and because I gave myself time to be sure that a career in medicine is what will most likely make me happy.

During high school I thought frequently that I had made my decision, once and for all, to attend medical school. When I applied to colleges, I was accepted into the University of Rochester Early Medical Scholars program (REMS), an eight-year college and medical school program. But when the commitment date came, I chose Yale University and its liberal arts program of study. Looking back, I realize that I didn't really know even then that medical school was the right choice for me. All I had to go on were good grades in my high school science courses, encouragement from my family, and some volunteer work in the radiology department of a local hospital. Clearly that was something; but I was apprehensive about making medical school a foregone conclusion without even having started a pre-medical curriculum.

In college I have had a number of experiences that have allowed me to conclude that attending medical school is the right choice for me. First, I generally enjoyed my pre-medical courses, although during my first two years I changed my mind several times because various classes interested me or discouraged me. I liked one semester of chemistry and biology but not the other semester. I liked organic chemistry, but I didn't like physics as well. It really took two upper-level biology courses (biochemistry and biological reaction to injury) to convince me that I would like a medical school curriculum.

To my surprise, studying for the MCAT was actually encouraging because I saw how the courses I'd taken had prepared me for what lies ahead.

My major is in history. Although I took the science courses necessary for medical school, I wanted to be sure that I wasn't forcing myself into a medical career and away from any opportunity to attend graduate school or law school. If you have other interests it is probably wise to pursue them while in college. This will allow you to keep options available, provide you with a more rounded education, and give you time to get to know yourself, your talents, and your interests. I know medicine is what I want to study not because I have taken only science courses but because I like it best of all my options.

The greatest impetus to attend medical school has come from my work-study job. I work in the department of surgery for a laparoscopic surgeon. I've had the opportunity to spend a great deal of time observing in the operating room, as well as just watching medicine at work, learning what the life of a doctor is on a daily basis. A lot of physicians in the department complain about having to deal with paperwork and bureaucracy, but I am still attracted to medicine, and especially to surgery. It has been incredibly beneficial to work in the research and clinical setting of a medical school for nearly four years: it gives one a chance to see how medical students, residents, fellows, and attending physicians must deal with the day-to-day pressures and responsibilities of medicine.

My reasons for wanting to go to medical school are not based entirely on school and work, though. My brother, Jens, has cystic fibrosis, and throughout the past few years I have spent a significant amount of time, during vacations and summer months, keeping him company in the hospital at the University of Pennsylvania, when he has to go for lengthy treatments. This experience with him has shown me what a difference good doctors can make in a person's life. A doctor must be willing to put up with insurance companies and other bureaucracy for reasons other than monetary compensation. Having grown up watching doctors care for Jens, I have found some of those reasons and I hope to have the same impact on people someday as the doctors treating my brother have had on my family and me.

Although it wasn't until my third year in college that I decided to attend medical school, I felt that I made that decision with enough experience to really make it final. If you are unsure about medical school, leave your options open. Chances are that if medicine is right for you, you won't need convincing. When the time comes to apply, you'll know.

N.B.: Bjorn Herman graduated from Yale University in 2001 and is now doing a research fellowship at Beth Israel Medical Center's Advanced Medical Technology Institution in New York City. He plans to enter medical school in 2003, and aspires to be a surgeon.

LYDIA PACE

An English Major Coming into Medicine

I am writing with my leg propped up on a stool, a bag of frozen peas balanced on top of the high-tech, hinged, and Velcroed brace that encases my swollen knee. Tearing my anterior cruciate ligament (ACL) in my knee a few weeks ago was a painful experience in obvious ways, but it was also an important one. It has made many aspects of medicine real to me in a way that until now I mostly understood in terms of philosophical abstractions, or simply from the point of view of an observer. And it has made me feel astonishingly right about my four years of being pre-med.

The most disorienting aspect of this ACL experience has been my adoption of the identity of a victim. For the first couple of weeks after the accident I hopped down the street on my crutches, waited for the Special Services van, or hobbled into my classes feeling terribly aware of being seen as a disabled person. I am a disabled person-I became one in the split second that my knee "popped" on the ski mountain. It's a strange feeling, especially at this fast-paced institution, which values strength and independence so much, and for someone who has difficulty asking for help with the most ordinary tasks. It has been hard for me to accept my inability to change my situation, to accept the fact that I can't run, dance, or ski for the rest of the season. It is hard to confront the mysteriousness of my body's workings and the fact that my ligaments failed. It's hard to look at my knee and have only a vague idea of what is going on there.

Two years ago, when I read Oliver Sacks's memoir A Leg to Stand On, I thought a great deal about the effects of injury on identity, and the elusive and complex relationship between our physical and emotional states. After reading the book I felt more legitimate in considering medicine as a career. I had sometimes questioned my place in the world of natural science; I felt surer of my place in the world of poetry and human emotion. But it is only during these past few weeks that I have felt for myself, keenly and constantly, the way that physical ill health can dominate every aspect of our lives and selves. And I understand in a much deeper, more personal way the effects of injury and treatment on identity. It has become impossible for me to doubt a doctor's involvement in the deepest parts of a person's experience.

My recent encounters with health care professionals and institutions have driven home some of my vague notions about the way medicine does work, as well as the way it should work. We all know the importance of connecting as human beings with our doctors and nurses; we know the incalculable value of a kind word or sincere question. But when confronted with what has probably (and thankfully) been the most serious health crisis of my life so far, I found that each real human interaction that I had-in the clinic, at the ski mountain, in the radiology department, in the brace shop, in the orthopedic surgeon's office-felt comforting and restorative to me as the person I know myself to be rather than only as the injured person I'd become. And each rushed or impersonal encounter felt deeply jarring.

Just as significantly, I realized again, at first hand, how crucial it is that doctors make their patients feel a part of their treatment or diagnosis. I have read a bit about medical ethics, and I have talked a fair amount to disadvantaged people in emergency rooms and shelters who feel mystified and terrified about their health and their experiences in the hospital. I have felt strongly, for a while now, about the necessity of empowering individuals in their own health care-both in order to enhance quality of care and promote prevention and as an acknowledgment of a patient's dignity and humanity, of a doctor's own limits and humility, and of the importance of fostering a doctor-patient dialogue rather than a power game between doctor and patient. Yet it wasn't until I felt my own huge frustration with not knowing exactly what and where my knee's ligaments and meniscus were that I realized that these efforts toward educating patients about their bodies or ailments are not mere gestures. I felt like hugging the first doctor who pulled out a rubber model of the knee to show me how it works. I've learned that the education of the patient, along with compassion, connection, and communication, is an essential part of health care, for both practical and psychological reasons. And these elements are not simply what differentiates a good doctor from a bad doctor: they are components, I think, of any doctor's true calling. I feel strongly that these are any patient's essential rights. Granted, I feel this way with the self-righteousness of the patient and the student who has not yet felt the demands of medical school, the all-consuming and compelling nature of the technical aspects of medicine, the unpleasantness of the "nightmare" patient, or the harrying elements of managed care.

Finally, becoming aware of the possibility that my health insurance might not cover all my costs, particularly my $735 brace, and encountering the ferocity of the stressed secretaries in each office, I was forced to imagine what it would be like to have no insurance at all. I thought about what it would be like to live in dread that a health crisis could occur that would quickly overwhelm my financial resources. I felt for myself (though, because I am lucky, only for a few moments) what it really means to have one's basic right to health care dictated by economics and ability to pay.

Throughout these revelations (most of which came together in my mind while I was lying prostrate in the magnetic resonance imaging [MRI] tunnel listening to that shocking jackhammer sound), I tried to remind myself that my experience had to be one of the easiest ones anyone can have. I am a white, English-speaking, upper-middle-class student from the same sort of ethnic, cultural, socioeconomic, and educational background as many of the doctors I encountered. I am an easy patient who nods trustingly at my doctors, who can understand the idea behind the surgery, and who can be counted on to ice my knee, do my leg lifts, and take my Vioxx. All of my past experiences had taught me to see doctors as my allies. And yet to do that in this experience has been far from easy.

My exposure to the other side of the doctor-patient dyad has intensified my desire to work with people who typically have the hardest experiences with health care-whether because of cultural differences or a lack of resources (money, education, technology, at home or in their hospitals). The only jobs I've ever held have involved working with people with AIDS, inner-city children, or homeless women. "Social service," or "social justice," the only career fields I've ever investigated, became my angle into medicine. I want medicine to be my way to connect with people, to reach them at moments of crisis, to make them feel safe without making them feel utterly dependent on the expertise of doctors, to make them feel as if they can help themselves be healthy. These parts of health care are what make medicine meaningful for me. They are the thoughts that I have held onto as I've made my way through premed-ness at Yale, when transcripts acquired disturbing and inauthentic significance, when my career sometimes seemed to depend entirely on my performance in a fifty-minute midterm or when I spent sunny summer days studying organic chemistry under fluorescent lighting.

I have often doubted my decision to be pre-med, a decision I didn't really make until sophomore year in college. I have questioned the motivation of my sense of justice (doesn't it just make me feel good?); I have wondered whether I picked medicine just because it provided direction, because it feels good to be able to say "I'm pre-med." I have always been a poetry person, an art person, a flaky person-what was I doing thinking I could do medicine? If I can get stressed out over an English paper, how will I possibly make it through medical school? How will I deal with the stress of a busy day at the clinic, let alone the responsibility for human lives? I want to have a family, too; I want to go rock climbing in the summers; I want to read and write. How will I do those things as a doctor? Aren't there other ways to work with people, to advocate for them, to empower the poor or travel to developing countries? When it comes down to it, will these words really mean something? Will I put them into action? Or will I just burn out?

And I question the probability of my ideals. A doctor reading this might wonder at my naivete, my assumption that I can make my career what I want it to be, and that medicine can retain its meaning for me even in the complications of the twenty-first century and the assembly-line nature of modern health care. Maybe I'm wrong to criticize the way things are-or often are. My visions give little room to practical concerns like money, and I never think that perhaps I won't be able to support a family while working at a clinic in South Africa or the South Bronx.

Throughout these past few years of being pre-med, it has been most important for me to see medicine as something I can truly envision myself doing, something I have a right to be doing, to have a place in, and to have a vision for. Once it had become a part of me, despite those inevitable doubts, I found that it was harder to imagine not being a doctor.

Continues...


Excerpted from THE YALE GUIDE to Careers in Medicine & the Health Professions Copyright © 2003 by Yale University/Institution for Social & Policy Studies. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Preface
Acknowledgments
A History Major: Why I Wish to Attend Medical School 5
An English Major: Coming into Medicine 8
A Science and Humanities Major: Listening 13
A Pre-Med Major: Tackling the Pre-Med Decision 18
A Science and Humanities Major: The Inspiration of Purpose 22
A Hospital Chief of Staff: The Medical School Decision 31
A Premedical Advisor: On Applying to Medical School 38
The Chairman of an Admissions Committee: Preparing for Medical School 43
The Director of an M.D./Ph.D. Program: The Purpose of M.D./Ph.D. Programs 49
A Conscious Evolution in Medical Education 55
A Surgical Resident: In Service to Nation and Medicine 59
A Medical Resident: Preparing for Medical School - The Four-Year Plan 64
A Psychiatrist: Becoming a Psychiatrist 69
A Cardiologist: Character Counts 74
A Former Medical School Dean: Learning in the Twenty-First Century 78
Medical School: An Overview of Medical School Education 89
Beginning Medical School 95
Choosing the M.D./Ph.D. Program 99
The First Clinical Year 105
Teaching Medical Students 110
Advising Medical Students 115
Residency and Graduate Study: The Ups and Downs of Residency 121
A Resident's Night in the ER 127
A Chief Resident Reminisces 134
The Inspiration of Medicine and Research 137
Balancing Research and Medicine 142
Medicine as a Profession 153
A Physician's Character 159
Faithful Physician 166
The Humanities and Medicine 170
Medicine as a Calling 176
Three Rules of the Road: A Social Worker's Lessons 327
My Life in Medical Social Work 332
A Career in Public Health 337
Coming to Medicine Through Anthropology 343
Lessons from the History of Medicine 349
Coming to Medicine Through Health Psychology 359
Why I Chose Chiropractic 364
Some Musings About Complementary and Alternative Medicine 369
On Being and Becoming a Physician-Scientist 379
A Bioethicist Concerned with Research Involving Humans as Subjects 384
Conducting Patient-Centered Research 389
A Career as Physician-Scientist: Is It Worth the Effort? 394
The Path to Laboratory Research 401
Medical Informatics: Computers and Patient Care 407
The Rewards of a Life in Science 412
The Role of the Physician-Executive in Health Care Management 421
The Role of Physician-Executive in the Pharmaceutical Industry 426
Excerpts from How We Die 435
Excerpts from The Exact Location of the Soul 441
Contributors 447
Index 465
Credits 473
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