CHOOSING THE HEALTH CARE PROFESSION: So You Want to Be a Doctor?
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One Doctor's Perspective

I wanna be a doctor!!!
"I wanna be a doc and will do anything short of getting good grades and MCAT scores in achieving that goal." "I wanna help people just as long as MD is behind my name." "What can I do that looks good on an application?” Would being an RN help my chances for admission to medical school?

RNs are RNs.  MDs and DOs are MDs and DOs. Rock musicians are not classical musicians, although both are musicians. RNs are not Docs, although both are health professionals. There are elements of RN prerequisites that overlap with physician prerequisites; however, the way that knowledge is used can be quite different.

There are three life experiences that I wish my twenty year old students could understand.

• Are you prepared to see a new patient every ten minutes in which you greet, assess, diagnose, advise, produce legal records, and charge a fee?  Every ten minutes for six or more hours a day you do that. Every day, every day, calls at night, every night, every day, forty or more people parade through your office, your life, each wanting something from you. Are you prepared to develop an office staff that will help you greet, assess, diagnose, advise, produce legal records, and charge a fee? Do you see yourself as an employer of four or more people who attend to you like workers preparing the queen termite? Every day, insurance issues, Medicare issues, office issues, and sometimes even health issues with which to deal. Every day; Day after day, week after week, month after month, and year after year.

• Have you dealt with sick people?  People who smell bad; People who curse. People who are miserable. People who die. People who do not pay their bills. People who will not follow your advice. People who want your advice for free. People who are confused. People who are senile. People who no longer care. People who are addicts. People who have no concern for your privacy. People with whom you share secrets, sometimes dark secrets. People who insert you into their lives. People who are filled with fear, overpowering fear.  People who lie.  People whom you must touch, touch in private places.

• Can you live with your decisions? Are your decisions advised by knowledge? Can you read a person in a way that advises your decision? Can you persuade a person to do something she does not want to do? Can you communicate with a person in such a way that they understand you? Can you deal with your own mistakes? Can you deal with the fact that you will make mistakes as a medical professional? Can you cheat death? Can you find more than one way to affect a cure? Will you practice defensive medicine? Will you practice efficient medicine?  Will you practice inexpensive medicine? Can you make decisions in a multicultural environment?

What does a twenty year old premed, or pre-anything, know of the mundane, of being ill, of making important decisions?

One can become a CNA in less than a summer. Nursing homes need CNAs. One can make far more money as part of the wait staff at an expensive restaurant as opposed to working at a nursing home. 

• What is it like to help a double amputee 85 year old woman on and off the toilet, or into and out of a wheelchair, or perhaps the shower? 
• What is it like to feed the "grazers" at the dinning room circle tables?   
• What is it like to wipe the excrement from the behind of an 80 year old man with severe Parkinson's? 
• What is it like to break up a wheelchair jam in the hallway of the Alzheimer's wing? 
• What is it like to hold the blue, frail hand of a 94 year old woman who has outlived all her relatives and she is trying to tell you that she knows she will die tonight, and does? 
• What is it like to tie a birthday balloon to the bed rail of an 82 year old gentleman who has no idea what time of day it is? 
• What is it like to listen to an 89 year old lady who lived in Japan from 1951 to 1954? 
• What is it like to answer a policeman's questions as two men in dark blue suits remove a body from a bed? 

All of this can happen during the course of a weekend shift at a nursing home.

The daily events of a nursing home reveal a great deal about people, about health or its absence, and about the business of providing health services. It says a great deal about the mundane, about being chronically ill and making decisions about everyday life. It is a place that has physicians' directives, DNRs, and patient turnover.  

It is not the ER, the surgical suite, nor the biomedical lab. What it is... is life near its end. It is about death. It is about people who look fear and death in the face. It is about people who are lonely and sad. It is about people for whom time has stolen their personality. It is about the will, the fortitude, the grace, the experience of people for whom life's door is about to close.

If you have students who want to experience medicine, health, illness, and treatment, has them consider obtaining CNA credentials for nursing home employment. They can have their fill of cancer, heart disease, arthritis, incontinence, motor failure, and mental failure all in one place at one time. They can meet and work with patients who have traveled life's journey, acquired vast amounts of wisdom, and who know their fate. These people's observations are keen, their comments incisive, and their humanity bare for all to see. I can't think of a hand's on experience in health care that can be any more intense and instructive than working as a CNA in a nursing home.

If you have a student who is looking for an affiliation with health care delivery, have him look at nursing home care.