I got an e-mail from a young electrical engineer the other day who was interested in psychiatry and asked me about some ideas he had to increase his exposure to the process of talking with patients. He was interested in some experience with this before considering a change to medical school and psychiatry. As I thought about it today, it brought back some memories about how science and math majors have been discriminated against at times in the medical school admissions process. Back in the day when I was initially considering an application to medical schools, there was a General Knowledge section on the MCAT - (Medical College Admissions Test). It was there purportedly to select people who were "well-rounded" and not just science majors with their shoulder to the wheel studying math and science. Well rounded seemed to mean liberal arts majors and people with a broad exposure to art galleries, museums, theatre and culture in general.
There were a couple of things wrong with that theory. First of all, it biased the test toward anyone who lived in a major city. If you were a hayseed like me, you made a school trip to the Guthrie Theatre in Minneapolis exactly once in your high school career. For everything else - you better be paying close attention to what happened in your English literature class. Not a very dynamic approach to learning. Contrast that experience with a friend of mine who is a New York born and raised Internist. He had very broad experience with all forms of art including opera and ballet before high school and is one of the most brilliant people I have ever met when it comes to discussing and critiquing art of all forms. All of that most likely originating in a childhood and adolescence steeped in the artistic milieu of New York City. I know he didn't learn it in medical school. Who do you think would do better on the old General Knowledge test?
The second problem is the general assumption that people involved in the humanities are more likely to be interested in people and take a humanistic approach to medicine. There seems to be a bit of a loose connection there between temperament, personality and your intellectual pursuits. People in the hard sciences must be rigid, lack warmth, be oblivious to the human condition, and lack empathy - right? I have never found any solid evidence to support this. I will concede that Communications majors do an outstanding job at weddings. I recall going to a wedding where I knew the groom since he was an infant. When he grabbed the microphone and launched into 30 minute impromptu act, I asked him where that came from. His answer: "Communications major." Apart from that, I have asked many good psychiatrists what their major was as an undergrad and a surprising number were Chemistry majors. Those chemistry majors had no defects at all as physicians or psychiatrists. They did as well as anyone else and I was glad that they were in the field.
As far as I can tell, the previous bias against science majors getting into medical school did not have a rational basis. I can't be certain about whether or not it exists today but I can be sure that administrators keep manipulating the entrance exam. In this commentary from a couple of years ago I point out that the stated goals of aspiring to think like a scientist is probably very congruent with being a senior level science major. But I don't think that will translate to an admissions bias in favor of science majors.
Are there reasons to encourage engineering, math and science majors to go into medicine and psychiatry? I think that there most definitely are. At the highest levels, the technical aspects of brain science are exploding and future physicians and psychiatrists with a grounding in scientific thought and information science will be able to make the best use of it clinically and at the research level. All of medicine is currently in the throes of very crude clinical trials that are often limited by a lack of specificity. Most medications prescribed have limited efficacy and significant side effects. That means just from the medical side, physicians in the forseeable future will be managing these medications and their side effects. I think that a few dimensional comparisons across medicine and science and engineering may be useful:
1. Economics - physicians are currently overworked and much of that work has little to do with patient care. Practically all of the people managing physicians are right out of a Dilbert cartoon. Most of medicine has been reduced to a rapid prescribing paradigm and businesses are recruiting non-physicians to do it. That has already led to a reduction in the quality of care in psychiatry largely by eliminating psychotherapy, time spent with individual patients, and systems considerations of care. Engineering in particular may be a more financially sound career with the opportunity to escape the fate of Dilbert. Economics are not the only consideration. I recently encountered a young petroleum engineer involved in oil exploration who was very successful and decided to go into medicine. When I asked her about her motivation she said she wanted to work with and help people - even if it meant a significant hit to her salary and autonomy.
2. Intellectual Satisfaction - scientific endeavors especially at the business level produce clear measurable results and the process frequently incorporates the theory that you learned along the way if you are an engineer. Medicine and psychiatry are much more diffuse. There are administrators and politicians ordering you around under the mantle of science who clearly know nothing about it. You may find colleagues that are really not interested in the cerebral aspects of the field only the practical. In medicine and psychiatry that can be stultifying when you realize that this involves a series of political arguments about conflict of interest and drug trials.
3. Conflict of Interest - Medicine and psychiatry have been under attack for some time by people who believe that there should be no contact with private industry, at least at the level of reimbursement for work being done. All payments from private industry need to be reported in a national database and needless to say that discourages physicians from working with with the pharmaceutical or medical device industry. This is a significant difference with engineering. As an example, I contacted the IEEE and asked them about their policy on standards and was told that they encourage the participation of industry in the discussion of standards because of the expertise distributed within the industry and the need for those active discussions. Medicine and psychiatry, largely due to the questionable theory that the industry will affect treatment decisions has embarked on a period of isolation from medical industries that may be alien to technical fields - especially to engineers.
4. Politics - We are in a 30 year period of unprecedented discrimination against physicians by state and federal governments. Like most American politics the implicit goal seems to have been to bring all physicians under the management of companies that are proxies for governments and on the face of it that strategy has been highly successful. Practically all physicians are employees of large health care companies and supervised by people who know practically nothing about the work they do, but who are quite content to tell them how to do it. Many of these policies, like recertification have a significant impact on physicians and their families. They are not conducive to the idyllic balanced lifestyle.
5. Subjectivity/Uncertainty - There is a high degree of subjectivity in medicine and in many circles that is considered a dirty word. Most non-physicians fail to see the importance of subjectivity and how it relates to information transfer in biological systems. The least creative try to pretend that it doesn't exist and they try to reduce everything to a 10 point scale. They mistake these "scales" for objectivity and some sort of measurement. They don't really understand what scientific measurement is. They base entire systems of care on these failed measurement systems. They can't be reasoned with and there has been a large proliferation of measurements that are quasi-scientific at best but that are used to assess physicians and processes. Frequently meaningless data is collected and used to make decisions about care and how systems of care operate. Physicians in these settings with a knowledge of science and measurement can be very frustrated.
6. People - I have posts about the interpersonal dimension of treating people as a psychiatrist. It is more rigorous than the interpersonal landscape of other physicians. Psychiatrists treat a broad spectrum of problems and in some cases there are significant conflicts with the people you are trying to help that are based on an underlying mental illness. Some of these conflicts affect some physicians more than others. You may already be able to tolerate interpersonal conflicts better than your peers and that may make psychiatry easier for you. Psychiatrists are also unique in that they are the only medical speciality that has groups of people who dislike them and routinely disparage them whenever they have the chance. Being able to tolerate that will also make it easier for you to go into psychiatry.
These are some of the issues to consider if you are thinking about switching careers and going into medicine or psychiatry. Medicine and psychiatry are not sciences - but we need scientists, engineers, and mathematicians. They make good doctors and I am hoping that they can help medicine move out of the morass of political regulation and business theories and back toward the light. At the same time, it is only fair to consider that in engineering it may be more possible to find a better work environment, a better lifestyle, more intellectual stimulation and better reimbursement.
That's about all I can think of tonight. If you are a science or engineering student with additional questions - please feel free to post here and I will try to answer them about any specifics. Please see the disclaimer below.
George Dawson, MD, DFAPA
Supplementary 1: The e-mail I received suggested that I was an electrical engineer. I am not an electrical engineer. My major was biology and chemistry, but I am member of the IEEE largely though my work with a number of electrical engineers on electroencephalgraphy. I have been an IEEE member for 18 years.
