Oops; reposting comment as a new post:
I agree with Howard that physicians command (and deserve) a high level of respect simply because of the nature of their education, in the same way that PhDs and JDs command more respect than a BA or BS. Competition tends to favor those that are best at what they do, and there are are few (if any) professions more competitive than medicine, with med school admissions rates hovering in the single-digit percentages. I'm sure everyone's heard of the abuse of residents in clerkship programs and the rigor of specialty fellowships, so there's no need to preach to the choir.
That said, a good medical student will not necessarily make a good doctor. Medicine is a conglomeration of many fields, some of them disparate (counseling and biophysics, for instance), and it's hard to imagine that any academic institution (however rigorous, selective, or well-funded) could cover all the bases. Similarly, the traits that make the best doctors, such as empathy or grace under pressure, are not qualities that can really be "taught," but must be gained through real experience with real patients and real emergencies; that is, they're acquired after the fact.
I think doctors command respect not (necessarily) because they had a rigorous education, but because the healthcare system has granted them exclusive powers and privileges that do not extend to any other type of health practitioner. I believe these powers are derived from two different (but related) sources.
The first is the medical community. Clinical medicine is highly hierarchical in nature, with physicians at the top. After all, doctors--not nurses, physician assistants, paramedics, technicians, or anyone else--are legally responsible for the life of their patients. In a hospital, you can hardly blow your nose without getting a doctor's signature, and when treatments or procedures are not properly executed, the doctor is the first to be held accountable. This does not mean that doctors are entitled to carry this burden or that they all carry it well. The title "physician" commands respect not because all physicians have been outstanding medical leaders, but because leadership is something that comes with the job itself.
The second source of a doctor's unique powers are his patients. I think there is something truly astonishing about the doctor-patient relationship--that someone would voluntarily entrust a complete stranger with his life, and then (as if that wasn't harrowing enough) fork over an absurd amount of money to have this person pump him full of strange chemicals, slice him open, or tell him what to eat or drink on a daily basis, based on nothing more than faith in the stranger's job title. This is not like the relationship between you and your fireman, in which you either let him do his job or watch your house burn down on the spot. Any rational human being could tell you that a burning house needs to be put out, but only a doctor can tell you that 1) you have an invasive colorectal carcinoma; and 2) it can only be treated by topoisomerase inhibitors. Right. The only way you could confirm is to either see more doctors or become one yourself.
It is also not like the relationship between you and your teacher, in which failing to follow your teacher's recommendations will not lead to a slow and painful death.
The doctor-patient relationship is also not a case of paternalism or "the doctor is always right" as the cartoon above suggests. Doctors cannot legally force (or coerce) their patients to do anything. When a patient meets their cardiothoracic surgeon for the first time and says, "Sure thing, go right ahead and stop my heart and bring me back from the dead," it reflects the patient's voluntary consent, not the surgeon's mandate.
My point here is that it is the nature of the healthcare system that gives physicians such a high standing, and not necessarily anything the physicians themselves have done. The system makes it so that doctors have no choice but to sign off the orders of nurses, assistants, and technicians, have no choice but to become responsible for a patient's life, and have no choice but to accept the powers that patients grant them (except under the "right to conscience" executive order, which I will vehemently ignore for the moment). Medical students are not necessarily those members of society most capable of shouldering these difficult responsibilities; in fact, I would wager that most premeds have a romanticized (or overly academic) view of medicine. The responsibilities are simply thrust upon them as soon as they get a passing grade on their Boards.
It is the job, and not the person, that commands respect, and it is the healthcare system that describes that job. I think that if you changed the system such that the job description changes, physicians as a population would lose their high standing, regardless of the rigor of their education or training. However, I feel that there is nothing wrong with the job itself; after all, someone has to do it. And since we are all prone to human error, I think the public needs to accept that some medical mistakes and inefficiencies are inevitable. However, I believe there are others that can be avoided, if only by changing the way that doctors are selected and trained, or how their interaction with their patients and peers is regulated.
That said, a good medical student will not necessarily make a good doctor. Medicine is a conglomeration of many fields, some of them disparate (counseling and biophysics, for instance), and it's hard to imagine that any academic institution (however rigorous, selective, or well-funded) could cover all the bases. Similarly, the traits that make the best doctors, such as empathy or grace under pressure, are not qualities that can really be "taught," but must be gained through real experience with real patients and real emergencies; that is, they're acquired after the fact.
I think doctors command respect not (necessarily) because they had a rigorous education, but because the healthcare system has granted them exclusive powers and privileges that do not extend to any other type of health practitioner. I believe these powers are derived from two different (but related) sources.
The first is the medical community. Clinical medicine is highly hierarchical in nature, with physicians at the top. After all, doctors--not nurses, physician assistants, paramedics, technicians, or anyone else--are legally responsible for the life of their patients. In a hospital, you can hardly blow your nose without getting a doctor's signature, and when treatments or procedures are not properly executed, the doctor is the first to be held accountable. This does not mean that doctors are entitled to carry this burden or that they all carry it well. The title "physician" commands respect not because all physicians have been outstanding medical leaders, but because leadership is something that comes with the job itself.
The second source of a doctor's unique powers are his patients. I think there is something truly astonishing about the doctor-patient relationship--that someone would voluntarily entrust a complete stranger with his life, and then (as if that wasn't harrowing enough) fork over an absurd amount of money to have this person pump him full of strange chemicals, slice him open, or tell him what to eat or drink on a daily basis, based on nothing more than faith in the stranger's job title. This is not like the relationship between you and your fireman, in which you either let him do his job or watch your house burn down on the spot. Any rational human being could tell you that a burning house needs to be put out, but only a doctor can tell you that 1) you have an invasive colorectal carcinoma; and 2) it can only be treated by topoisomerase inhibitors. Right. The only way you could confirm is to either see more doctors or become one yourself.
It is also not like the relationship between you and your teacher, in which failing to follow your teacher's recommendations will not lead to a slow and painful death.
The doctor-patient relationship is also not a case of paternalism or "the doctor is always right" as the cartoon above suggests. Doctors cannot legally force (or coerce) their patients to do anything. When a patient meets their cardiothoracic surgeon for the first time and says, "Sure thing, go right ahead and stop my heart and bring me back from the dead," it reflects the patient's voluntary consent, not the surgeon's mandate.
My point here is that it is the nature of the healthcare system that gives physicians such a high standing, and not necessarily anything the physicians themselves have done. The system makes it so that doctors have no choice but to sign off the orders of nurses, assistants, and technicians, have no choice but to become responsible for a patient's life, and have no choice but to accept the powers that patients grant them (except under the "right to conscience" executive order, which I will vehemently ignore for the moment). Medical students are not necessarily those members of society most capable of shouldering these difficult responsibilities; in fact, I would wager that most premeds have a romanticized (or overly academic) view of medicine. The responsibilities are simply thrust upon them as soon as they get a passing grade on their Boards.
It is the job, and not the person, that commands respect, and it is the healthcare system that describes that job. I think that if you changed the system such that the job description changes, physicians as a population would lose their high standing, regardless of the rigor of their education or training. However, I feel that there is nothing wrong with the job itself; after all, someone has to do it. And since we are all prone to human error, I think the public needs to accept that some medical mistakes and inefficiencies are inevitable. However, I believe there are others that can be avoided, if only by changing the way that doctors are selected and trained, or how their interaction with their patients and peers is regulated.
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