Many medical students in the US might start out as idealists, looking forward to help those who cannot afford healthcare, but stark reality forces them into specialized streams. Public health suffers in the process.
Emily Breidbart, a second-year student in the New York University School of Medicine and who interned with the CNN despairs that conditions obtaining on the ground in her country, especially the insurance-related issues make students wary of general medicine.
Her father, a pulmonologist (doctor specializing in lung diseases), is tired of spending half of his energy dealing with insurance companies, Breidbart says.
Energy and time he would rather spend on his patients, time he had when he first started practicing in a health-care era in which doctors didn't need to justify prescriptions and tests to insurance companies.
He still insists on giving ample time to his patients, but now has to work incredibly long hours to do so, laments the daughter.
'We thirst for clinical experience. We want to explore all of our options, and help those who can't afford health care. But somewhere along the line, we start taking off our rose-colored glasses. I've seen it happen already with some classmates after only one year of school. We know that it is surgeries and procedures that are financially rewarded. Insurance companies reimburse very little for routine examinations....'
So although they might really be interested in primary care or pediatrics, after hundreds of thousands of dollars of debt many feel pressured to go into a specialty field that will ensure they can pay back their loans. Dreams and good intentions are put aside.
Many students steer clear of fields like Obstetrics-Gynecology because of the high cost of malpractice insurance.
We are taught about malpractice from Day 1. I remember countless times in the anatomy lab when we were digging for arteries and nerves, our teachers saying, 'Now if you cut this in real life, you would be sued,' phrased in terms of a legal consequence instead of the repercussion that the patient might die, remarks bitterly Breidbart.
This 'art of defensive medicine' infiltrates the classroom too. The students are taught how to ask questions of our patients and treat them in such a way that minimizes risk of a lawsuit. They are trained what kind of patients to be wary of. What happens then to the much needed trust between patients and their doctors?