On Being A Gadfly

Although this is the age of Evidence Based Medicine, in large parts of our country, the “E” in EBM does not stand for Evidence, and more often than not, means “Eminence”. Medicine, for a long time, was resistant to the influx of new ideas. While reading the Gawande article on the History of Surgery in the NEJM special 200th year celebration edition, we were all duly reminded of the rapid strides the science of Surgery made in the last two centuries. Now though “Surgical Research” sounds like an oxymoron these days, the late 1800s and early 1900s saw an explosion in the knowledge base of Surgery. However, one thing I think the article glossed over a bit was the resistance of the development of the field in the initial days…

In all branches of Science, the doubting Thomases have been subjected to persecution and ostracization from the powers that be. In the days of yore it was the Church, and in modern days it is the ivory-tower riding beneficiaries of the status quo.

In a recent editorial in Circulation: Cardiovascular Quality and Outcomes, Dr. Harlan Krumholz goes on to write an open letter to the younger inductees into the profession. He asks us to do just one thing: Be brave! And in my opinion, that is a very important message. Personally speaking, this has bolstered a bit of a radical decision I made myself. I would be lying if I said I blasted through the postgraduation entrance examination (that is the entry exam for residency for Indian medical grads, akin to the USMLE, but much more of a pain in the backside), but I had managed to pull in a semi-decent rank. I had the option to go for the money-spinning disciplines like ENT or Anesthesia or Radiation Oncology but I decided to listen to my heart and went for Preventive and Social (aka Community) Medicine. I strongly felt that this is a branch that has to offer so much more than it has done till now and I decided to be a part of the game. There was a lot of resistance from friends and family since the future of the subject is rife with uncertainties, but I wanted to try and make a difference. And all the while, I was plagued with indecision and fear over going against the flow.

And somehow, Dr. K’s article (which was sent to me by the inimitable Dr. Richard Lehman) hit home with me. I just needed to be brave and back myself, back my decision. I have always been the one to take my own calls (and I have had to suffer more than my fair share of pain for that) but I never regretted any of it, because all the while, I was doing something that I was really passionate about, that gave me joy and made me feel that life was worth living.

I just decided to take that call again…

Are you a young medic with new and innovative ideas that questions the status quo? Are you a whistleblower trying to blow the lid off the next big scam? Are you the “plain ol’” medical student flabbergasted by the vagaries of a psychotic education system? Are you a medical student on the cusp of making the most important decision of your life, and wondering whether to listen to your head or to your heart? Then, just take the plunge, and do what I did: Be Brave!

In conclusion, I leave you with the words of two intellectuals that have relayed the concept of being brave in two apparently very different manner:

From Rabindranath Tagore:

I have drunk of the poison so willingly…

Reference:

Harlan M. Krumholz. Editor’s Perspective:A Note to My Younger Colleagues. . .Be Brave. Circ Cardiovasc Qual Outcomes. 2012;5:245-246, doi:10.1161/CIRCOUTCOMES.112.966473 Extract – Full Text – PDF