So it's been a little while

I'm still developing this thing/blog in my head, trying to decide if it is a good idea or not. Looking back on some of the older posts, I think it might be. The title is a little strong and some people might not like it, and it could get me in trouble with the higher-ups if they find out who's writing it, but it does somewhat agree with my ideas at the moment. Maybe I just don't want to commit to conservatism or liberalism. Maybe by trying to be brash I'm actually wussing out, taking the third road to avoid getting beat up by either side for being on the other, and allowing me to argue against everything. It does open me up for criticism from pretty much everywhere, but I'm being anonymous...at least I think I am. I never really know how much people can find out about these blogs.

Anyway, I'm in the end of my Third Year now and am really trying to figure out what kind of a doctor to be. Its down to a few options, Family, Internal and Neurology. Diagnostic, therapeutic, but light on the procedures, over a wide range of topics.

Family because I like the variety and the ability to know a little about everything. They get to work with all ages and all systems of the body. Mostly clinic, a smattering of emergencies (mostly cardiac where people don't know they're having a heart attack), and a few minor procedures depending on your local medical politics. In a big city, you do less cutting, sewing, scoping and freezing because other specialists don't want their turf stolen. In a small town, you can basically do everything and anything you want/feel comfortable with/need to yet don't feel comfortable with. With my personality, I think I'd end up in a larger city though. I might get squeezed out by RNPs and PAs from the bottom and surgeons and dermatologists from the top. It is still the one I feel is like the "true doctor" though.

Internal because it's complicated and basically puts off the decision to choose a specialty another few years. I think I'd do kidney stuff most likely. But that's mostly from a Doc I followed for a few days who I thought was pretty much a god among men, so who knows if I'll actually like it. Its a harder residency than FM, mostly in the hospital. I'm doing that rotation next so I'll let you know what I think of it then.

Neuro because its awesomely cool. As in you get to study how the freaking brain works and how it interacts with the world (dare I say CREATES the world??). With my background its the mostly intellectually stimulating system of the human body because it makes us human, it defines our being in a way no other system even comes close to. You get to work with people who have no emotional response to the face of their wife of 15 years afte a stroke, but lights up when she calls him on the phone. You also work with degenerative diseases like Parkinsons and MS. Stuff we haven't quite figured out but will shine in the next 20 years. It is the century of Neurosciences, this one.

If you can't tell, I'm leaning Neuro right now. But if I go that way, can I do mission work in inner cities or the third world? Maybe, but I won't get my hands as dirty will I? I'll need MRIs sometimes. I think. They do have some pretty amazing physical diagnosis skills though.

I don't know....


My politics is of less interest to me at the moment. I'll get on to that later, when there is some sense of where the government is going to go.

I attended a video conference today on heath care reform put on by AMSA and the AMA reps in my class. We talked with a senator's aide about the upcoming bills in the Senate and how they may or may not affect us as soon-to-be doctors. We talked about medicare reform, the public option and mandating insurance for all American Citizens. I realized during the talk that part of the problem with heath care today is that it is a business. We want to put the "incentives" in the right spot so more people choose family practice or general surgery in small towns where more people have medicare and doctors get less compensation, so hospitals will cut excess costs and 'medicare fraud', so insurance companies can still make money while paying for our health problems, but still prevent me from having to pay for your medicine. We want to cut costs without sacrificing service, we want to extend care without institutionalizing and assembly-lining it. We want it personal and cost effective.

There are too many conflicting needs in the system. We need to realize that we can't do everything. For the health care system to 1) be more cost effective and 2)less susceptible to litigation requiring "CYA" medicine while 3) keeping medicine personal is impossible. To be more financially solvent requires a movement towards the 'mammograms only starting at 50' type of thought. Preventative care for everyone is not necessarily cheaper than paying for a few people's major problems. We just have to be comfortable with more people dying than absolutely have to if we would have checked everyone starting at 25. In order for the system to be less litigious, we would need universalizable regiments of care, requiring large amounts of paperwork and consulting to create and even more if you think your patient is different than the 'average' person the regiments are designed to be helpful for. If money is the bottom line there is no solution possible.

It was a play about honesty, with oneself and with the world and its about the dreams we often have and almost as often give up on. There was conflict between family and society. Who wins? Save the family and betray the social order, or let lose the family when the greater good calls for it? Who are our families?

There was a doctor in the play. He was really the voice of the writer in this show it seemed. He was the one to bring up life's focus on practicality. We can't always do what we want, because it is not practical. It won't support our family or the lifestyle we wish to display ourselves living. And we give up on those dreams, watching our honesty disappear.

I hope I'm not doing that. It bothers me sometimes to think that what I am doing with my life, everything that's happening with my life, might be happening because its practical, its a "good idea." I get all worked up sometimes worrying about if I'm really being true to myself. And then I realize you can't really know unless you act, unless you do something with your life. I can't sit paralyzed by the fear that I'm not doing what I'm "supposed" to be doing. I'd rather just do things I think will help at the moment with out bothering about the "purpose" behind them or whether it "fulfills" me or not. Whatever I do, if I do it well and my heart is in it, will be what being true to myself means. I get to decide what it means by deciding to act. Because, who am I without action? You are what you do. The tough part is doing it with your heart.

Maybe that's what I'm really worried about...that I don't have a heart with which to do meaningful things or with which will feel the beauty behind the actions.

the begining?

So, I'm not totally sold on my blogs name yet, as I'm not entirely sure how people will take a anarchist doctor, or even if you can BE an anarchist doctor. But this is just a test, to see if I have what it takes to blog and to stick up for my beliefs. And I'm a med student anyway, I don't have to put an MD after my name for a good three years yet.

I've only recently become aware that I have severe anarchist leanings. I was brought up a capitalist, became a socialist for a while (if only in thought), and have come to realize that the most moral and egalitarian position one can take in the world is anarchy. It doesn't assume the stupidity of the masses and the need for a caretaker to oversee societal functioning. It doesn't bank on cut-throat competition among unequals, never-ending consumerism and environmental destruction in exchange for short term gain. Anarchy depends only on the inherent goodness in people. I have a desire the desire to see the world as a good place and a place where people don't need rules to tell them respect for the other is a good in itself. If humanity needs policing to tell them that murder is wrong or that cooperation creates the best outcomes for everyone involved there is something incredibly wrong with how we raise our children. I know it is not a plausable or effective way of running a society and might lead to ruin, but hey, that's what anarchy is against anyway, "running" a society. I belive love and mutual respect and trust are the most moral basis to live by and to interact with others, not laws and edicts, not five year plans or...commandments. If someone slaps you, turn the other cheek. If they slap you again, turn your cheek again. They will eventually tire, or humanity is already lost forever. Thats why I want to be a doctor. I trust people will learn from their mistakes. I will help fix people to the best of my ability, physically, psychologically and spiritually. Some things will be beond my power, and some things will take me to the limits of myself and tear me down. I hope I can take it.