AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2002, Volume 4, Number 1.

From the Editor

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Bottled 1986, Opened 2001

Reading his medical school application of 15 years earlier, the journal editor finds that his motivations for entering medicine can be better appreciated as his career unfolds.

Audiey Kao, MD, PhD

On a recent morning while housecleaning personal papers and memorabilia, I rediscovered something that prompted reflection on my reasons for wanting to be a doctor—my medical school application essay. On as much real estate as I could carve out of an 8 ½ by 11-inch plot, I had constructed a narrative meant to convince strangers of my genuine desire to be a doctor. I could recall experimenting with a variety of literary styles, but ultimately settling on a direct approach, putting aside penned gimmicks designed to capture the attention of admissions committees. Had the fruits of my labor aged well over time, like bottled wine? Or had the reasons for choosing medicine that I expressed more than 15 years ago turned sour? I was about to find out.

Uncorking this bottle to test the vintage gave me cause for concern. The anxiety arose in part from the fact that, over the years, I have had opportunities to critique essays from others who wanted to pursue careers in medicine. As a result, I have developed an experienced palate that I use in judging the integrity of authors' motivations as expressed in their own words. I have read few essays that fail to reflect on the applicant's idealistic reasons for desiring to be a healer. If the applicant has too romanticized a view of medicine, I question whether the idealism is frank and genuine, having met few saints in my life. If, however, I think the extreme idealism is sincere, I then worry that this individual will encounter difficult times on his or her path to becoming a doctor. Therefore, applicants who convey some personal uncertainty and anxiety about pursuing medicine may, according to my ranking scheme, actually be better prospects for medical education because they appear to be more accepting of imperfection and, thus, less prone to disillusionment. Finally, I have a jaundiced view of applicants who write about their interest in a specific specialty in medicine. Maybe it's just a pet peeve, but I simply don't think that, at that point in their lives, individuals are able to know in any informed way what kind of specialists they will want to be.

Now I was turning that critique on my expressed reasons and motivations for wanting to be a doctor. My initial read left me with less than a satisfying taste in my mouth—I violated my own pet peeve by writing about my interest in ophthalmology because I had worked in the office of such a specialist. (My history substantiates my critique—I did not go into ophthalmology.) Given my experiences in medicine since penning the essay, the primary reason that I espoused for wanting to be doctor seemed naive and simplistic—the fulfillment that comes with knowing one is educated and equipped to help people who are sick and in need. What I did not realize then (could not have) was that what I had termed the "obligation to care" would be severely challenged during my medical education, training, and clinical practice. There are occasions now when I dread the visit of a specific patient. This professional reality can be profoundly disconcerting and seemingly contradictory to my past aspirations and motivations.

What also struck me upon further review of my essay was its simple ordinariness. My reasons for choosing medicine were not all that different from those expressed in many of the medical school application essays I have read. This narrative link, while it may reflect some practical aspect of "The Successful Medical School Application Essay," may also reveal a fundamental thread that binds all those who decide upon medicine as a career. No matter how different applicants may be, they share expectations about a physician's duties or obligations that are informed not by professional experience, but rather by how each of them wants and expects physicians to be. There will always be challenging patient-physician relationships in our professional lives. But that in no way diminishes the integrity of our motivations to enter medicine.

As we get older and, we hope, wiser, we are better able to appreciate the fullness and complexities of the earliest motivations that drew us to consider this healing profession. Therefore, uncork that personally bottled wine of yours and savor its contents—it just may be a perfect vintage.



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