Medical

Answering The Most Common Question in Medical Education

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
Doctors-in-training have heard this question thousands of times, beginning the moment they announced their intentions to pursue a career as a physician: The question, of course, is some variant of “What kind of doctor do you want to be?” Before I interviewed for medical school, I was told to answer noncommittally; it was suggested that, if I already knew what kind of doctor I planned to become, it would imply the clinical years weren’t important to me. I was told to leave it open-ended so as not to rule any specialty out too early. I see the value in that—looking back, how could I have possibly had a good idea, given my limited clinical exposure before medical school? Even for students that do have clinical experience, it’s easy to imagine they could change their minds and, regardless, should be open to learning from the clinical years. Similarly, we were told not to answer too definitively during third year either—the idea being that if we tell an attending what we want to do, and it isn’t the specialty we are currently working with, we will be permanently alienating ourselves from that profession.
It can be helpful to come up with your own way of answering the question, recognizing that it will likely change over time. You should answer honestly, being aware that how you phrase the truth can go a long way to connecting with the person asking the question. Years ago, as a high school student, I was shadowing an ER doctor who gave what I thought was the best answer. He asked me the question, and when I mumbled that I wasn’t really sure yet, he said “No, no, no. This is how you answer that: Say, I want to be a good one.” And I’ve used that line pretty much ever since. It makes people laugh, but it’s also true: regardless of specialty, we can all aspire to be good doctors.
But what makes a good doctor? This is not an easy question to answer. It is the subtext of most medical school interviews: The interviewer may ask what kind of doctor you want to be, looking for a simple answer about specialty, but the whole interview is really about them figuring out what kind of doctor you will be. Will you be a compassionate one? A strong-willed leadership-focused one? A quiet, hard working one? Will you work in a local hospital, serve the poor in a foreign country, or seek a rural practice? There are as many different kinds of doctors as there are doctors, and many of them are good. Being “good,” though, means something different depending on the context. Competence is always critical, but the other personality traits that we all carry might mix and match in ways that allow us to function as very good doctors, despite being so different from each other.
Consider as an example a pediatrician I’ve worked with for several years. He has done just about everything – lectures, administration, hands-on clinical teaching, and patient care, and is one of the best teachers I’ve had. He is also an incredible pediatrician. He has an upbeat, slightly goofy demeanor that naturally builds rapport with children and their parents, and he understands the unique challenges in caring for children. He’s given several of the lectures so far in our Pediatrics clerkship, and I’m amazed every time he shares at his level of thoughtfulness and concern for treating patients correctly. He has years of clinical experience, coupled with some natural talent, but I think he truly excels because he is always asking himself how he can do better—and pushing students and other doctors to do the same.
His skill set, though, might not serve him as well in some other fields. Pediatric oncology, for example, also works with children, but requires a very different mindset than a general pediatrician who sees mostly healthy kids. Trauma surgery requires different skills as well; a good trauma surgeon might not make a good pediatrician and vice versa. Further, patients might define a “good doctor” very differently, depending on past experience, personal needs, and individual preferences. There is no cookie-cutter mold for what makes a good physician.
However, there are some common threads. As I mentioned, competence within one’s field is essential, and forms the basis for good patient care regardless of specialty. Other traits, such as respect and compassion for patients, constantly seeking to learn and improve, and good communication skills are fairly essential, but even these manifest themselves in different ways. Showing compassion in end-of-life care might not look the same as showing compassion for a teenager with behavioral concerns. The conversations a psychiatrist has with his/her patients are very different than those a surgeon has with his/her scrub nurse, though both require precise communication. These nuances between fields have been very interesting to see, and might provide a clue as to what it is about certain fields that attracts individual doctors-in-training.
As I’m moving further into my role as a third year student, I’m beginning to understand that my answer of “a good doctor” is not enough. It’s a given at this point that I will seek to be a good doctor; I will continue to watch those around me for the specific skills and attributes I want to incorporate into my own career. I have heard many doctors suggest that their process of determining a specialty choice had less to do with the specialty itself than the people in it. One doctor in particular recounted how every physician he wanted to be like was a pediatrician, so he determined that pediatrics was where he would best fit in. Even if this process doesn’t work for determining a specialty, I’ve already found that paying attention to specific attributes of the doctors I work with and emulating them has made me a better medical student, and I hope it will make me a better doctor. And if by chance it helps me figure out what specialty to choose, that would be fine too.
About the Author
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.

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Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshoft School of Medicine. His professional interests include medical humanities, mental health, and medical education. Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshof...