Fat City →

Incredible article on obesity, how we got here, and what we all have at stake 

“A recent New England Journal of Medicine article dealing with the rise of chronic lifestyle-driven diseases calls for a change in the way physicians think about their patients. The author suggests that medical students should be taught to be less reductionist, to learn how psychological, social and economic factors all act as determinants of disease. I do not know what medical school is like in the US, but even our surgeons – the most hard-arsed of doctors – sit reeling before the tragic combinations of circumstance and choice that lead our patients to weigh two or three (or four or five) times what they should. The doctors I work with have an excellent grasp of the bio-psycho-social factors that contribute to our patients’ states, but we are only doctors. All we have are the tools of our trade: our ears, our voices, our hands, our pills and our scalpels. The waiting rooms are full, the waiting lists are long, the demand is swelling. Obesity is in many ways the logical endpoint of the way we live. Prevention beats palliation, but we’d need psychologists, motivational speakers, social workers, dieticians and physiotherapists to work with us in order to have any hope of tackling the problem. We’d need policy makers and activists. All we have are doctors like me.”

life auditions

When I was an undergrad there was a columnist in the school newspaper written by a then-medical student at Duke. I read these columns because he was funny, but also because he had achieved something I aspired to, and articulated week after week, what it meant to him to pursue medicine, frustrations and all.  One week, he challenged his (probably) largely pre-med audience to consider the question – “why do you want to be a doctor?” I didn’t have a good answer, really. My parents were doctors and growing up, I had never seriously stopped to consider any other career options. I knew I liked working with people and I had followed the tried and true pre-med paths into research labs, shadowing, and volunteering activities. But I was missing something.  Being pre-med felt like a stressful – and not very fun – game of checking off a lot of boxes, and felt rather removed from the real doctoring with real patients and very real sickness. I tore out that column and stuck it into a folder, frustrated that it had stopped short of answering the question for me. But I kept coming back to it, even as I periodically veered off the prescribed path altogether.

Five years since I read that article, I’m finally applying to medical school. I have since realized that medicine is much bigger than I thought it was as a freshman in college. And after tours through banking, consulting and now global health, I have seen that healthcare is much more complex, our roles as (aspiring) future physicians much more nuanced than I had imagined.

My reasons for wanting to be a doctor have since matured beyond the requisite interest in science and in helping people, but I also hope I never stop discovering reasons why medicine is a worthy and enriching choice for a person’s life’s work. I know the dynamism of people’s stories of struggle with and triumph over illness will never cease to draw me in, and the charge of delivering the best within this resource constrained world will continue to be a worthwhile challenge.  I know that medicine is messy even through its precision, and that though technology will be an enabler of better outcomes, human ingenuity and compassion must continue to be the drivers of innovation.

Though this audition is long and sometimes disheartening, I’m glad that it encourages plenty of reflection and requires a good dose of self-awareness. Regardless of the outcome, I’m happy to have gone down this path on my own terms, and following my own interests. I am trying to embrace and cherish all this excitement and possibility, and trying to practice patience, confidence, humility.