work

Interview

Medicine as Vocation

Q&A with Daniel Sulmasy

by John Shorb

Written by John Shorb on September 15, 2010

John Shorb

John Shorb is the founder of Church Health Reader and served as editor from 2008-2011. He is a visual artist living and working in Brooklyn, New York. Visit him online at johnshorb.com.

See all articles by John Shorb.

Daniel Sulmasy, MD, is author of The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals and The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. He is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago and associate director of the MacLean Center for Clinical Medical. He spoke with Church Health Reader about vocation and medicine.

John Shorb: In The Healers Calling you wrote that you generally ask resident applicants to reflect on their initial motivations for going into medicine. How do you see medical education shaping their initial motivations, particularly whether they keep them or lose them?

Daniel Sulmasy: Most people who come into medicine do so for good reasons. They come often saying that they want to help people – that’s probably the most common answer that someone will give when they are doing medical school interviews. They also say that they like science, and this is a way to use their scientific knowledge to be of direct benefit to people. A small number will be explicit about having a religious motivation for doing so though few will actually use the word vocation. Most people have something of a vocational sense, a sense that there is something different about medicine. One way that philosophers put it is that, “when I go to the shoe salesmen, my feet are the issue; when I go to the accountant, my taxes are the issue; but, when I go to the doctor, I am the issue.”

Most people come in with good motives. What happens, sadly, is that there is little support for maintaining those kinds of ideals and motives within medical school. No one rewards people for having those kinds of ideals and there’s certainly no testing on it. It’s hard for someone to be expelled from medical school for character defects – they would sue immediately and it would be difficult to prove that there was something about their personality or motivational structure that was the problem even though it might be obvious to faculty and even to their own peers. There’s evidence, for instance, that these character defects become apparent when they begin to have clinical experience. Sometimes that’s a self-protective effort on the part of interns, residents, and medical students to be a little cynical, to have some dark humor, but sometimes those things can come to be dominant.

When people see that they’re rewarded for being efficient, for knowing all the facts, sometimes the workload is so great that all they can be concerned with is getting the work done. It can be physically demanding as well: there can be little sleep quite often and some of this begins to erode the humanism in medical students. There are a number of studies that show that that begins to happen. It’s one of the reasons, why, when people come to interview for internship I ask them this question: “what did you say when you went around on your medical school interviews about why you wanted to be a doctor and what do you think now and how has it changed?” That gives me some insight to what’s happened to them during the training process.

When they give you that answer, what’s the most common sentiment?

The most common answer is that nothing has changed, which means that they have not been thinking about it, because something should have changed. If they were reflective, they would recognize that there were things that changed about it. From my own personal experience, I went into medical school pretty naïve. I was the first college-educated person on either side of the family – I didn’t know the difference between an internist and an intern, for instance. There was a lot for me to learn, to be acculturated to. It is about learning to struggle with balancing ideals against these kinds of demands; when somebody says “nothing has changed,” that is disappointing to me. It means they haven’t been as reflective as a good physician ought to be about the process of education and where their soul is in that process.

How do you view vocation?

Vocation, simply described, is a calling. It is God who calls us and calls us to be the person we have been created to be, to fulfill God’s plan for us. It is what we in our deepest most central part of ourselves, actually most desire. The match of those two is our vocation, one and the same when our will and God’s will are one for what we should do in life. Everybody in that sense has a vocation.

There are particular kinds of occupations that are more particularly viewed as ministry. Those are the kinds of traditional ministries of being in the clergy, or being part of the liturgy, being in the choir, being a deacon within a church. But then there are also, at least within the Roman Catholic tradition, particular kinds of works that are classified officially as ministries and those works are what we call the “corporal works of mercy” which come from the list of Christ’s own discourse about where we find him. We find him, we’re told, when we visit the sick, when we clothe the naked, when we feed the hungry. Healthcare is one of those particular kinds of “corporal works of mercy” that is ministerial. When your call in life is to be a minister and your total work is doing that particular work, it is one of those special vocations–vocation with a capital “V”—that is every bit as equivalent to the vocation of being a minister.

From the beginning of recorded history, the roles of priest and doctor were unified, right? The shaman was the healer and certainly it has been significant in the history of Christianity that this work of being a healer has been seen as spiritual kind of work. There is something special about illness and death and those who minister to it and those who are able to heal. It is central to the Christian message, and it is part of the good news. It is part of what Christ announced, and it is part of what he sent the apostles out to do – to heal the sick and preach the good news.

If a medical student applicant comes to you, what would you initially tell them about what they are facing? What advice would you give?

I’d probably talk to them about those same kinds of questions, “what is cooking in your life?” “What is making you think this is what you want to do?” “Why do you want to do it?” I try to get a sense from them of whether they are in it for the people, which is the main reason to be in clinical medicine. Then I let them know that I think that it is an exciting way of life, despite all the difficulties. Sometimes the doctor’s dining room in a hospital, particularly a community hospital, can be one of the most toxic places these days. There is a lot of complaining and a lot to complain about: the increasing bureaucracy, cut backs in payments, pressure to see more patients, more people sticking their noses into medicine, malpractice lawsuits, and frivolous lawsuits.

But in the end, it is not as if we are setting off to fight the plague. We can have a little bit of courage; we can put up with all of that bureaucratic hassle if we are in it for the people. If I find a zeal for service within that person, then I want to talk to them about the ways in which they can continue to cultivate that, nourish that, and draw upon it as a resource throughout their career in medicine. It is one of the great lines from the scriptures when Jesus casts the moneychangers out of the temple it says, “zeal for your house consumes me.” It is actually the New Testament quoting the Psalms: “zeal for your house consumes me.” Well, I want the person for whom medicine is a temple, medicine is a house for God and that zeal for that house will consume us. When we have that kind of zeal, we will be able to push the moneychangers out of the temple of medicine.

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