Determinism and Medicine

A few days ago, I finished my first semester as a medical student. Initially, despite my hardest efforts, I struggled. As I got into the flow of studied, my marks and attitude vastly improved. Of this fact, I am very proud. I met a challenge, adapted out of necessity, and carried on without incident.

The terrifying part of the matter is that the whole ordeal seems like a large, almost homogenous blur. It is a very vivid blur, but the jumble of terms and concepts that I now know so very well are not neatly organized into chronological order. I feel like I simply know all we learned for the first semester. I describe it as terrifying because that 4-month stretch of my life is seemingly unaccounted for; I am wiser and more erudite as a result, but the intensity at which I studied left little time for taking conscious snapshots of times and places.

I’m not saying I can’t remember anything. When I press myself, I remember going to the beach, cooking for the South Asian Student Society food sale, etc. But largely, I feel like I’ve become a being of the present. I am enjoying a few stress free days of break and gearing up for the consequent grueling semester ahead of me.

Moreover, I don’t know if I like this change. I feel almost like a passive observer, sometimes going through the motions of studying, relaxing, etc. because there truly is no other choice than to do these things at the deemed times. I know that this is how society operates in general; people have schedules and shift work where they may cover certain time spans and go home for a certain time spans and rinse repeat until they are old and their lives lived.

These thoughts have reminded me of another association I was making in my head – the general feeling of determinism in medicine. I’ve described my personal feelings on this as they relate to my studies above, but this tangentially ties into a greater concept regarding the nature of medicine. Everything is so intricately cataloged and supposedly explained that that there is little room for deviation. While this makes medicine an exact science, it mildly takes away some of spontaneity of life. People will always break their carpal bones and commonly fracture their scaphoid, women will always become pregnant as a result of several cascading processes involving fertilization and hormonal secretions, the median lobe of the prostate will always give benign hypertrophy, etc.

Everything is categorized and divided into deterministic events that are going to happen. And I know, of course, that the median lobe of the prostate can on rare occasions give rise to malignant cancer, but my point generally is that, on the whole, now that I am starting to have a good understanding of the human body, it feels like everyone has some pending doom over their heads waiting to be played out, echoing what I’ve learned in my classes and from my textbooks.

Similarly, as I know I will learn later, I will be given deterministic measures for how each of these scenarios will play out. For instance, I will later learn how long a break in the arm will take to heal, how it will respond to different conditions, etc. This adds to the sense that these events will happen and I will feel obligated to treat them in an exact way; otherwise I will be offering my faceless, nameless patients sub-optimal recovery.

Another aspect of this is the way physicians are educated to handle patients and think about them. Patients are categorized into broad frameworks that involve their personality types, the number of kids they have, and their occupation. Is it so simple to define an individual by these common themes? I know it is necessary, but I empathize and would feel strange knowing a doctor was thinking of me in such terms. In our book on the patient interview, we are taught that analyzing responses to phrases physicians say is a good method to gauge how a patient is feeling. There is a significant deal of psychology in that book, but my point overall here is that our instruction is so precise that we are taught even social interaction. There again is that deterministic feel; there is a list of scripted patient responses and a list of replies for each in every scenario given. Every interaction can be predicted and optimally responded-to in order to ensure patient compliance and satisfaction

I think, especially with that last piece about the patient interview, physicians are explicitly trained to follow established protocols; this casts a sense of looming inevitability and determinism about the whole discipline. There is always something a physician is “supposed to do” in order to properly provide care. This is why, more than anything else, I am interested in research. It provides that lacking element of creativity and flexibility to an otherwise rigid practice.

So, that was more of a rant about the confines of medicine and the way its material is presented.

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Achievements

As I understand it, there are two types of achievements.

The first type of achievement is personal. I think this is the type of thing most people, myself included, strive for on a daily basis. These are things like getting perfect marks on exams, excelling physically, improving your body composition, getting a degree, etc. These things are methods of bettering ourselves as individuals. Most successful people in society proceed by excelling at personal achievements and going forwards from there. For instance, a medical student excels in his or her coursework and knows the proper physiology and anatomy of the human body well enough to become a practicing surgeon. For some, that in itself is a personal achievement.

The second type of achievement is more lasting. It isn’t a personal achievement, but, it is a sort of existential achievement. This requires broad vision and drive. I am having a hard time describing how it is different (but not opposite) from a personal achievement, so I will give examples. Establishing a library or a hospital or a school in a severely impoverished place in the world. Doing pro bono work with your advanced degree. Modifying a staple crop to make it more vitamin-rich, preventing blindness in millions of children. Bridging the gap of private and governmental space flight programs. This sort of achievement affects many, many people. It is the kind of achievement that can take the help of hundreds for the sake of one resounding goal.

While the two achievement types are different, they can have some overlap. Many (if not most) people spend their lives working for organizations with such broad oversight. I would include hospitals in the list of such organizations, and many doctors have larger goals to help as many people as possible. They provide a necessary service, but the pace at which they change the world is necessarily slow and personal. Often times, public health policies can have a larger impact on the face of a populace, but not always greater.

I guess the main difference is that personal achievements mean something to the achiever, whereas the other types mean something to others. I don’t want to make out pursuit of personal achievement as selfish; self-mastery is an important part of being an individual and life. Ideally, one can strive for both simultaneously and harmonize the two.

Personally, I am trying to accomplish both. I want to become a physician, which I think had feet in both territories. I want to participate in research that will come to fruition and affect medicine and quality of life globally. I want a stronger, leaner body. I am actively pursuing these goals; with time I will accomplish them.