I am writing to respond to Paul Szerlip's Viewpoint, "Applaud the pre-meds ... applaud the problems," published March 29 in this newspaper. As a former competitive premed student (c-pres), I have a different opinion of these people and their take on competitiveness, grades and volunteer work. I also argue that the issues of bioethics underlying medical decisions and the influence of the pharmaceutical industry are more complex than what Mr. Szerlip makes them out to be. In summary, let me say that I am honored to know premed students and have them in my classes. These c-pres will be our physicians and medical leaders of the future and I am happy to support the best of them.
A good c-pres earns excellent grades. Is this all through rote memorization? I think not. Just ask any organic chemistry or calculus student. There is no way that one can do well in these courses by simply memorizing reactions or equations. I am sure that my colleagues in other sciences and the humanities can make similar arguments. Sure, you can demonstrate some knowledge by memorizing but the best students really reach for understanding and connection to other fields, and they are often c-pres.
These excellent grades are in part, a product of the highly competitive nature of the c-pres. It is a trait that is often associated with those who reach the pinnacle of success, and is certainly not owned by the c-pres community. Just look around at successful people in our society and ask yourself who among them isn't competitive? Bill Gates? Competitive. Bill Clinton? Competitive. Tom Brady? Competitive. Why not budding physicians? You don't need to be Mother Theresa in order to do good things or care about people.
This point about doing good and caring leads me to the issue of volunteer work. I can see why people may be cynical about the extracurricular activities of the c-pres. Many a c-pres, such as myself, initially undertook volunteer work because it was seen as an unwritten requirement for admission into medical school, not because he or she had a strong desire to stock shelves in the intensive care unit. Volunteering, however, was a great opportunity for me to explore life outside of the ivory tower of our campus. I spent time volunteering in hospitals, coaching for Special Olympics, tutoring and working in the laboratory.
In doing so, I realized that I loved teaching and research, which is why I am here now. Because I was compelled by "the system" to go out and explore these other opportunities, I found a better fit for myself. For other c-pres the experience of shadowing a doctor or observing activities in the intensive care unit while keeping supplies stocked may reaffirm their commitment to taking up this noble profession.
With this viewpoint in mind, I cannot believe that the majority of c-pres are so Machiavellian and "self-interested" that as physicians they would "refuse to perform operations on certain people because it's too 'risky,'" because a failed operation would "mess up the surgeon's statistics which in turn will decrease the likelihood of them becoming chief of surgery or getting some prestigious new job." I just cannot believe that. The decision to undertake a risky operation is an agonizing and intensely personal one between the patient and his doctor. What is worse, a life-threatening operation or a life-threatening condition?
To reach beyond Mr. Szerlip's provocative statements and address the issues more directly, I will say that the state of medical training has not kept pace with our fast-moving society. In an interview with the Journal of the American Medical Association, Tufts' Distinguished Professor of Medicine and former Editor-in-Chief of the New England Journal of Medicine, Jerome Kassirer, argued that, "The human classroom of the hospital is obsolete; the lecture format lacks efficiency and may be outmoded" and that students are learning in an increasingly "conflicted web of pharmaceutical influence." Medical training has also fallen behind the advances in biomedical research, such as genomics, proteomics, nanoscience and tissue engineering, that are transforming the diagnosis and treatment of disease.
The Association of American Medical Colleges released a report in 2003 entitled, "Educating Doctors to Provide High Quality Medical Care: A Vision for Medical Education in the United States." In it, a panel of medical deans called for a revision to the traditional approach of training and practicing medicine to produce doctors who, among other things, will take a, "humanistic approach to medicine," "a patient centered approach to medical care," and have "an appreciation of the importance of fundamental research for the advancement of medicine." Other blue-ribbon panels have made similar calls.
I believe that we are at the beginning of a shift from an authoritarian style of training towards an approach that better emphasizes the patient and blends effective communication with a multidisciplinary approach to diagnosis and treatment. Perhaps in time, this shift will mitigate Mr. Szerlip's distaste for his medically oriented classmates. I feel, however, that the qualities of a good c-pres, namely strong work ethic, high intellect, desire to make an impact and willingness to serve society, will lead to good doctors in this century as they did in the last.
David H. Lee is an Assistant Professor of Chemistry at Tufts.
