What Are the Worst Jobs for a Doctor?

Mary Black, a public-health physician in Serbia, offers her ideas in the current issue of the British Medical Journal (abstract only). [Yes, I know: two posts in two days from BMJ — but hey, it’s interesting stuff.]

Black’s criteria: “[T]hese are jobs that seriously compromise ethical and moral standards, are difficult to justify to your children, and are likely to be a source of regret on your deathbed.”

Here is Black’s list:

1. Head of medical services at Guantanamo Bay.

2. Research scientist at any major tobacco company.

3. Biochemical weapons developer.

4. Surgeon in the commercial kidney transplant trade.

5. Sports doping doctor.

I would also be interested to hear from physicians about their ideas of the hardest jobs in medicine. Personally, I don’t know how anyone can be a pediatric oncologist. But thank goodness for individual preferences, and that lots of other people feel different than I do.


egretman

Ha! I knew you were a charlatan, R.AndyFromCanada. If you had gone to ORU, you would know that it's doesn't have a med school because it was closed down in 1989.

I bet you are not a Randy or from Cananda, are you?

But since the subject is ORU, I will give you a chance at redemption.

How tall was the jesus that appeared before Oral Roberts and told him to build a hospital and that it would be a great success?

a.) 600 feet tall
b.) 666 feet tall
c.) 900 feet tall

hanmeng

Different people certainly have ethical and moral standards, and things they wouldn't want to tell their children on their deathbed.

The two jobs that particularly stood out for me as perfectly acceptable were the last two. I believe that there should be a commercial organ trade, and as for sports doping, why is that wrong, but does that mean other performance-enhancing techniques, like altitude tents, multivitamins and weight machines?

And the same holds true for the hardest job. Different people can handle different things.

R.AndyFromCanada

Silly egretman, you girl.

A) I graduated in 1987.
B) I am Canadian, I would not lower myself to unitize with anything other than metric.
C) Jesus was Canadian - - little known fact.

chancey

how about the ones performing lethal injections to criminals?

my friend's doctor wife works with cancer patients every day. believe or not she reads people magazine to de-stress at home:)

brtyler

By "Head of medical services at Guantanamo Bay" the author must mean its difficult to have to provide medical care for a bunch of terrorists who would kill you if given the opportunity.

SteveSC

I am sure there a people who can rationalize that the fetus is just "a mass of cells" (aren't we all a mass of cells?) but it must still be rather difficult to take a mass of cells with tiny little hands, feet and a face and drop it into the waste bucket. Not that I am saying it should never happen, or that those docs are bad, or anything like that. It just must be hard to balance one life against another, and then destroy one.

To get back to Dubner's question, another hard job is that of nursing home doctor. Lack of resources, patients in declining and poor health with complex problems, families whose interactions are often outrage over some failing of the facility/staff, a constant flow of people in and some indeterminate time later, corpses out...you can save some patients with cancer, but last I heard, you can't prevent death forever. Oh, and poor pay and little respect to boot. You can argue about prisoners and the abortion stuff, but I think most everyone believes that nursing home residents need, and should get, good care.

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egretman

It just must be hard to balance one life against another, and then destroy one.

No, not really. Not if one is a mass of cells that the woman has a right to turn into a baby or not.

SteveSC

So 'egretman' believes everything is hunky dory because "the woman has a right to turn [the mass of cells] into a baby or not." Let's postulate this is a moral position. Does it then follow that anyone who has a LEGAL right to "kill a mass of cells" has a MORAL position to do so? What if the 'mass of cells' is a convicted killer and the legal right is the right to enact the death penalty?

There are people who object to one or the other of these scenarios on moral grounds, yet approve of the other. What is the difference and where is the dividing line? Note that it is difficult to get doctors to serve in either capacity, thus I would conclude that no matter how strenuously proponents believe in the 'rightness' of their position, in actuality BOTH actions are very hard and cause moral qualms.

egretman

What is the difference and where is the dividing line?

Simple. It's the law of the land that the woman has the right to convert the mass of cells into a baby or not.

See? Simple.

brent

"Simple. It's the law of the land . . ."

So according to this brilliant logic:

It was morally correct for southern landowners to own slaves in the 1800s because it was both legal and constitutional at the time.

It was morally correct to deny women suffrage until the early 1900s because it was both legal and constitutional at the time.

Sisyphus

Hypothetically, the ethical dilemma of being a physician at a place like Guantanamo is the possibility that the very fact of providing medical care sufficiently alleviates the conditions of prisoners there--preventing death from certain brutal treatments, for instance--allows that very treatment to continue.

egretman

It was morally correct for southern landowners to own slaves in the 1800s because it was both legal and constitutional at the time

Wouldn't you think that slaves are a little more than a mass of cells? Maybe it's just me. But I can see the difference. Is this really so hard?

b

the hardest job in medicine is being a good general surgeon. I am not a general surgeon, only an internist. Which is the second hardest job,...

The above two specialties are expected to handle "whatever comes in the door" while extending courtesy and compassion to upset families and harried staff. Most consultants can ride in after the front lines have borne the initial brunt and masquerade as "the specialist" saving the day. Their efforts are idolized and revered. The work of the generalist is expected. This is why both fields are being shunned by medical students.
b

lermit

I'll just sum it up: Copyright editor.

.lermit

Nir Levy

I doubt any doctor could make more than #2. I think some people would actually not mind the job because of the challenge.

Then there was the research guy in Thank You for Smoking that "could disprove gravity if we paid him enough".

I would love to do some additional reading about where money and incentives over-ride moral principle/ethics.

kolya

If I had the talent for it, I think I'd go for #3... monetary incentive or no. Maybe I'm a terrible person, but is it that much different from rocket scientist? I'd get to hang out with Oppenheimer in hell.

#4 sounds kind of cool.

The people you'd have to deal with in #5 would kind of suck.

brent

"Wouldn't you think that slaves are a little more than a mass of cells? Maybe it's just me. But I can see the difference. Is this really so hard?"

You would be the perfect southern landowner during the 1800s. Your opinion is identical to theirs.

Slave-owners firmly believed that slaves were not fully human and therefore could be treated like property (gee, just like a clump of cells!)

conchis

egretman. please stop. you're giving respectable pro-choice types a bad name.

redfivemd

Worst jobs for a doctor? That's easy. The one that they don't love. I know people who are VERY anxious to become urologists or gastroenterologists, despite having frequent daily interaction with other's rectums. A surgeon doing a psychiatrist's job would be undergoing mental torture and would most certainly not be performing at the highest level. Treating cancer patients can be extremely emotionally exhausting but there are thousands who do this job for decades simply for the joy of being able to save some. In fact, I wish to eventually pursue a career treating cancer patients. As for those physicians whom one might infer they have an ethical dilemma doing their job, that is not always the case. For example, a pro athlete might ask for PED despite the risks explained to him by the physician. Military physicians are typically very moral and do their best to treat POWs, Gitmo detainees, and American wounded. The physicians are doing their best to keep all of those healthy are certainly not engaging in torture. Anyone who might would clearly be devoid of morals and therefor have no moral quadry with their task. Physicians struggle with ethics too, but overall I would rate them higher than most professions.

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egretman

Brent, how could anybody compare a mass of cells that a woman has the right to turn into a baby or not to a slave?

By what morality do you suggest such a thing?