Book Review

Life after Medical School: Thirty-two doctors describe how their medical careers were evolved and were shaped

N Engl J Med 1996; 335:1400-1401October 31, 1996

Article

Life after Medical School: Thirty-two doctors describe how their medical careers were evolved and were shaped
By Leonard Laster. 320 pp. New York, W.W. Norton, 1996. $27.50. ISBN: 0-393-71030-0

This book is pleasant to read, upbeat in challenging times, and a very personal account. The author — successively physician, investigator, administrator, and now writer — has interviewed 32 physicians about their careers. In his preface, Laster warns medical students against setting an inflexible, predetermined path and reassures them that there is seldom a single absolutely right decision with respect to one's career.

But this anthology goes much further than a manual for career counseling. The key word in its title is “life” — the progressions, changes, influences, and insights that come with real experiences after medical school. The conversations recounted here allow vicarious glimpses of fascinating lives, honestly and generally modestly told in the first person with what Daniel Federman calls on the dust jacket “almost psychoanalytic candor.” Most of these physicians are beyond the middle of their careers, and their stories are filled with unforeseen events or factors: new forms of technology, a new medical school, the careers of spouses, personal illness, malpractice suits, debt, success in research, the Vietnam war, and opportunities to satisfy one's social conscience. Medical students can marvel at the unpredictable transmutations and risk taking of these physicians. For example, a mathematician gave up research on missile-guidance systems for research on feedback controls in anesthesiology.

There are recurring and familiar points. The parents of these physicians valued education. Surgeons generally like action and the rewards of prompt and definitive results. Visual memory helps dermatologists. The “solitude of psychiatry” accompanies a tolerance of ambiguity. Many shifted to a more general practice or drifted into administration. Divorce is all too common. Most believe they have neither pressured nor discouraged their children about careers in medicine, and all wish they had devoted more time to family. They repeatedly advise students to know and be themselves, to seek mentors and alternatives, to recognize that no decision need be irrevocable, not to rush decisions, and to heed gut feelings.

The interviews do not specifically identify mentors but tantalize by naming cities, medical schools, and hospitals. Laster interviewed three black physicians, two in public office and one affiliated with Kaiser Permanente, and each adds dimensions and presents options not usually discussed in medical school. The contrasts pointed out between generalists and specialists form a helpful basis for making a first-order decision regarding the type of practice to focus on. The residency-program directors provide a more traditional approach to counseling than the practitioners and explain the process to the uncertain neophyte. Dr. Hermann discusses “the surgical personality” with charm, Dr. Barreira helps define what makes a psychiatrist, and Dr. Charney distinguishes between a generalist's and a subspecialist's interests and work in pediatrics.

A contrapuntal theme emerges from the views of five contributors that is political in nature but not distracting. Internists Relman (editor emeritus of the Journal ) and Dean (governor of Vermont) promote measured social strategies for ensuring basic medical benefits for all. Dr. Fantry, concerned about the homeless, urges the creation of low-income specialized housing. The pediatrician Dr. Elders, former director of a state department of health and former Surgeon General, advocates for children and health education, especially for the reduction of teenage pregnancy. Dr. Reynolds is eloquent and forgiving as he describes how the satisfaction from his practice and the encouragement of others helped him overcome the racial barriers he encountered. The careers of these physicians widen horizons and inspire. In summary, this book gives us a better idea of what makes doctors tick.

John A. Benson, Jr., M.D.
Oregon Health Sciences University School of Medicine, Portland, OR 97201