August 2007 | Back to Table of Contents
Editor's Note
Still a Helping Profession
The interviewer looked at me over his half-glasses and asked, “So why do you want to be a doctor?” As a college senior navigating the competitive rapids of medical school applications, I should have been intimidated. Yet I barely flinched. This question was a gimme. It was part of the ritual, as standardized as the MCAT I had recently taken, and I gave the same answer I had in previous interviews, a genuine response but so practiced as to seem calculated: “Because I want to help people.” Like medical school aspirants before and since, I singled out what I thought it meant to be a doctor—reaching out to others in need and placing their needs uppermost. It’s what some have termed “altruism.”
Indeed altruism is frequently included among the traits that characterize professionalism in medicine along with specialized knowledge, ethical behavior, and maintenance of competence. Defined as unselfishly acting for the benefit of others, altruism seems necessary to the mission of a physician. Physicians work with hurting, vulnerable people, and their welfare should govern doctors’ actions.
Yet today, some question whether altruism has anything to do with physician, or even human, behavior. Some biologists contend that acting for the sake of others is simply un-Darwinian and that individuals who do so will be quickly tossed out of the evolutionary lottery, eliminating “selfless” genes from future generations. A new generation of physicians also wonders whether selfless devotion to patients is self-destructive behavior. As noted by University of Minnesota sociology professor and monitor of the medical profession Frederic Hafferty, Ph.D., (p. 12), they think that defining altruism that way is what’s wrong with medicine—that “you can’t do that and practice good medicine.” Their message is that helping has its limitations, and there is only so much physicians should sacrifice.
Becoming a physician has always meant sacrifice: A minimum of seven years of training after college consisting of a brain-deluging flood of information and brain-numbing deficits of sleep. Work demands that rob physicians-in-training and physicians-in-practice of personal and family time. And educational debt that now averages well over $100,000 for physicians coming out of medical school. It’s never been easy to become a doctor.
Previous generations of physicians have sailed out of training and into practice without tacking, as if long work hours and little recreation were annealed to their genome and they were constitutionally unable to change course. I recently read an article about an internist retiring at the age of 88 after 52 years of practice who said he worked seven days a week and loved every minute of it. The new class of physicians would say that’s too much.
So what is the right balance between self-sacrifice and self-interest? Can we help our patients completely without a life-shortening pact to work sacrificially? Hafferty thinks altruism still belongs in the description of the medical professional; but we have to acknowledge that altruism’s definition is changing while maintaining the common theme of patient welfare.
One of our clinic’s employees recently left for medical school. He is the third person who has worked in our office while applying to medical school, and I like to think that we not only paid him a salary but did some quiet mentoring (see “The Mentor’s Image,” p. 24). As I walked into a room to bid him farewell, I thought about what message I should leave him with. I told him to work hard but find fun in every stage of his education. Later, as I wrote this column, I thought I should have left him with the enduring inspiration for the practice of medicine: Helping people should be why you get up in the morning.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org