“I Like (Political) Science and I Want to Help People”

I thought I was an oddball in college. I’ve only recently learned that I was avant-garde.

Right before beginning college in 1975, I decided I wanted to be a doctor. Being the first-born son – with decent SATs – of an upwardly mobile Long Island Jewish family, I had relatively little choice in the matter. Notwithstanding this predestiny, I felt confident that medicine was a good fit for my interests and skills.

But on my med school interviews four years later, I stumbled when the time came to answer the ubiquitous, “Why do you want to be a doctor?” question. The correct (but hackneyed) response, of course, is “I like science and I want to help people.” You’ll be comforted to know that I had no problem with the helping people part. It was the science thing that threw me for a loop.

It wasn’t that I didn’t like science, mind you. I found biology interesting, and organic chem was kind of cool, in the same way that Scrabble is. But I barely tolerated Chem 101, and disliked physics.

In contrast, I was gaga over my political science and history courses. Watching the Watergate hearings in high school turned me into a politics junkie, and I found that my real talents were in thinking about systems, history, and how to understand and influence the behavior of people and their institutions. My social science professors were dynamic, the reading was fascinating, and I had a flair for the material.

Yet I remained certain that I wanted to be a doctor.

As a senior in high school, I found a “How to Get Into Medical School” book that simultaneously frightened and reassured me. The frightening part was the admission percentages and the required GPAs. I was a good, but not great, high school student and the numbers were wildly intimidating, particularly since, to me, college was a scary and foreign place. (I was the oldest kid in my family and my parents had completed a total of one semester of college.) However, I was reassured when I read something like, “Medical schools no longer automatically reject non-science majors.” A chart displayed acceptance percentages by major, and I recall that music and English majors were as likely to get in as biochem majors, perhaps slightly more so.

So the day before I left for Penn, I puffed out my chest and told my parents that I was going to be a doctor… and a political science major. And that was that.

I was lucky enough to get into medical school (also at Penn). When I began, my goal was to become a practicing physician, perhaps also a teacher. My interest in politics and policy would remain an avocation, like golf or gardening. But, as so often happens, the Gods of Serendipity thought otherwise. When I was a 3rd year student, I met John Eisenberg, who was then a young professor of medicine at Penn. John was astonishing: movie star-handsome, charming and funny, and scary smart. He was a terrific clinician and teacher. He had an MBA, which was exotic, and his research focused on the healthcare system. It was through meeting John – who would later become the founding director of the Agency for Healthcare Research and Quality (where he was promptly dubbed “John of AHRQ”) but tragically die of a brain tumor at age 55 – that I realized that I could combine my social science interests with a career in medicine. And that’s what I did.

There are several things that bring this to mind right now. I’m writing from Vancouver, the site of the annual ABIM Foundation Summer Forum, which brings together a remarkable number of healthcare’s movers and shakers. This year’s theme is the future of medical education, and much of the discussion has centered on how to build a workforce of physicians (and others) who understand quality, safety, financing, leadership – all topics I began to think about in college. More than one attendee has remarked that – in addition to transforming our medical schools and residencies – we should rethink our medical school prerequisites.

The second item that brings this to mind is the recent publication by three UCSF faculty (David Irby, Molly Cooke, and Bridget O’Brien) of a book entitled Educating Physicians, commissioned by the Carnegie Foundation on the occasion of the 100th anniversary of the Flexner Report. I’ll say more about this powerful document, which addresses how we should be training physicians in 2010, in a subsequent post, but one of its top recommendations is that we rethink pre-medical requirements.

A third reason is last week’s New York Times front page story describing Mt. Sinai’s Humanities and Medicine (HuMed) program, which accepts 35 students every year with liberal arts degrees – students who, unlike me, have not completed standard scientific premed requirements, including taking the MCATs. A recent study in Academic Medicine compared the medical school performance of 85 HuMed graduates with 606 traditional Sinai students, and found that the HuMed students match the traditional pre-meds on virtually every measure (honors grades, research distinction). While there are methodologic caveats, this finding raises real questions about the importance of a scientific background in preparing for medical school.

Finally, last Friday I had a chance to meet with nearly a dozen UCSF medicine residents who are enrolled in our Leadership Pathway. All our residents are now encouraged to select a pathway (which you might think of like a college minor), in areas ranging from global health to clinical/translational research. Leadership pathway residents participate in a core curriculum in leadership, change management, and quality and safety, and complete a mentored project. This year, they analyzed a variety of physician payment strategies and presented their findings to leaders of the Pacific Business Group on Health. Prior groups have analyzed and improved our anticoagulation practices and our methods of communicating with primary care physicians when their patients are hospitalized.

My interest in political science, a chance meeting with John Eisenberg, and a whole lot of happenstance led to my career in policy, quality, and safety. In contrast, for the residents in our Leadership Pathway, interest in quality and systems change is anything but accidental. They are completely intentional in their desire to improve the healthcare system. They are devouring a real curriculum that gives them a skill set that I didn’t pick up until 20 years after graduation. Finally, they have stellar mentors (led by Drs. Arpana Vidyarthi and Read Pierce) who help them on the journey toward productive and satisfying careers.

Here’s my hope and prediction: In the future, all our medical students and residents will be schooled in the core principles of systems improvement and leadership, and many will receive advanced training. Moreover, within 5 years, undergraduate pre-medical science requirements will be relaxed and modified, and new social science requirements will help ensure that students have the foundational knowledge essential to systems change.

Don’t get me wrong – we don’t need all physicians to be poets and pundits, any more than we need them all to be molecular biologists. Medicine needs its world class scientists, and the system must continue to attract such folks to medical school. Nor do I favor eliminating all undergraduate science requirements. I agree with Emanuel (Zeke, not his brother Rahm), who wrote:

Genetics, molecular biology, and biochemistry are much more essential to medicine than organic chemistry and physics…. Rather than debate what to reduce or eliminate, it might be more valuable to focus on what should be required as part of medical education: communication, bioethics, statistics, health care financing, health law, and management sciences. 

Somewhere in an American college today is a student who wants to be a doctor but is passionate about policy, or management, or cognitive psychology, or ethics. My hope is that this student is encouraged to blend these interests, and that neither she – nor the members of medical school admissions committees – find anything odd about this combination.

9 Responses to ““I Like (Political) Science and I Want to Help People””

  1. exodus August 9, 2010 at 12:58 am #

    By choice or by circumstance, today’s primary care physicians often end up pursuing higher education in business, healthcare management and public policy in order to better understand (and hopefully, impact) the marketplace that consistently tends to shortchange them.

    The idea of diversifying entry requirements into med school is interesting. However, this is a niche that is already being filled by the numerous business and AUPHA accredited courses across the country. Collaboration with institutions that have core interests in these areas would be beneficial to all sides; rather than launching programs de novo.

    Just my 2c

  2. Davis Liu, MD August 9, 2010 at 4:17 am #

    Completely agree. I graduated from Penn from Wharton with a concentration in Accounting before heading off to med school at UConn. Everything I learned as an undergrad has played a significant role in my current position.

    The future of medicine requires that we embrace the best from all subject majors, careers, and experiences than what was considered normal in the past.

    Thanks for the personal and thoughtful post.

    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    (available in hardcover, Kindle, and iPad / iBooks)
    Website: http://www.davisliumd.com
    Blog: http://www.davisliumd.blogspot.com
    Twitter: davisliumd

  3. Healthcare Administrator August 9, 2010 at 7:02 pm #

    Nice post. I thought I wanted to become a physician and then I realized that I liked three things: business, health and people. So I decided to become a healthcare administrator. I certainly did not select a boring profession. For anyone who wants to become a physician and/or a healthcare adminstrator, one of the best courses you can take in college is Psychology. That class help you analyze and understand all of the “people” issues you will encounter :)

  4. annasims143 August 10, 2010 at 8:45 am #

    I love science. I hope I can be a doctor soon.

  5. contyler August 11, 2010 at 8:35 am #

    Political science and medicine can both have something in common.

  6. JadenS August 11, 2010 at 10:42 am #

    When I was in college I only took up the basics of Political Science. Since its only part of my basic subjects. But by nature I am a lover of solving and indulging in political issues. All i know about Political Science is that it deals with the study of the processes, principles, and structure of government and of political institutions; politics. Well, I wish I followed my mom’s advice, I should have taken that course since it fits me best.

  7. Bill Wood August 24, 2010 at 5:04 pm #

    Hi Bob – I am enjoying your blog , and this post in particular resonated with me. I was a government major in college – like you, I loved the classes, discussions, and reading materials – and still read political op-eds, watch political news programming and follow the polls. In college I was also a pre-med, because of my idealized image of a “doctor” through personal experience (i.e. my pediatrician growing up, and doctors in the family) and through physician-writers, though not because of a compelling attraction to the biological sciences (at the time). After my junior year in college, I did a summer internship at HHS and worked in a small office in the Humphrey building, alongside 2 physicians – Anthony So and John Eisenberg. I think that John (and Anthony) made the same impression on me that he must have made on you. (As a side note, one of the participants on the President’s advisory commission on health care quality that summer was Don Berwick, who subsequently provided some informal advice and tips on my college thesis). Those experiences indelibly impressed upon me that a career in medicine and an interest in the fundamentals of sociology and political science – really, an understanding of human motivation, systems, and a desire to make “business as usual” better – were entirely compatible. My career has taken a few twists and turns, and I’m now on faculty in BMT and malignant hematology – but with the same interests I’ve always had, and participating in outcomes research and process improvement. I owe a lot to the growing ranks of “physician-humanists” – of which I include Drs. Eisenberg, So, Berwick, Gawande, yourself, and many others – for my continued inspiration. Thanks for your affirming post.

  8. anhthumh October 16, 2010 at 7:25 pm #

    I like political science but dear god, please do not talk about Marxism or Communism. I am fed up with these. Actually I live in Vietnam, one of a few countries still under the Marxism regimes.

  9. arem October 18, 2010 at 8:08 am #

    Hi I’m also a political science student and an aspiring Doctor, this is very inspiring

    thanks for the blog :p

Leave a Reply