Medicine Science and Dreams: The Making of Physician-Scientists

Book Preface

I’ve always wondered what pushes or pulls people toward one career or another. Life choices make for life consequences, but what goes into these choices? The daily encounters, chance meetings, and derived opportunities, combined with the inherent individual values and attributes, allow one to weave through this complex maze of choices and settle on a life theme. While the fortune (or misfortune) of our families can, and oftentimes does, affect the breadth of our experiences, shape our values, and affect the scope of our options, I have been impressed that chance encounters with people outside the family have also shaped my values and have had a profound effect on my personal career opportunities and choices. In fact, these chance encounters do not represent random unrelated events but rather are influenced by a number of social, economic, geographic, cultural, and genetic factors that are integrally related to and derivative of each other. Despite this complexity, these daily, seemingly unrelated encounters serve to shape and reshape our lives, some events having far more impact than others.

It is these encounters and experiences that compose the stepping stones of our careers and that create traction and direction in our lives that I would like to explore as a way of understanding what moved me and others toward careers as physician-scientists. What were the high impact encounters? How did these encounters fundamentally affect our thinking? What are the inherent tradeoffs in the career of a physician-scientist? What are the events and responses that drew us to and keep us committed to these two somewhat disparate worlds of medicine and science? And are the worlds of medicine and science really that disparate?

Physician-scientists are unusual creatures. While we are drawn to medicine and the clinical challenges of our patients, we are also drawn to the opportunities that our patients’ medical problems bring to science. For a physician-scientist, going back and forth between medicine and science is natural and almost necessary. Both medicine and science stimulate each other, and it is the integration of these two disciplines that makes our work so unique and exciting. So while a physician-scientist might both practice medicine and explore novel scientific concepts, all of us strive to integrate medicine and science to create new knowledge. For us, one without the other just doesn’t work.

Although the future of physician-scientists remains a subject of debate and concern, the conceptual combination of medicine and science lies at the very heart of the practice of medicine. Science is a major component of medicine, and most people who go into medicine are fundamentally excited by science. However, the practice of medicine is often referred to as an art because it involves understanding people and placing that perception into a scientific context. The “art” of medicine involves integrating human behavior, social context, and science, and helping the patient make the best decision for his or her future. While we keep getting better at the science, we also need to continue to improve our skills in understanding the patient, his or her family, and his or her unique situation. Fundamentally, the life of a physician involves combining medicine and science to benefit the patient.

My belief is that every medical student has the potential and ability to become a physician-scientist. In editing this book, I could have chosen to put these choices and decisions in a historical context, conducted structured interviews with my colleagues, and analyzed the data. I could have structured the contributions of each author to address specific motivating experiences or conceptual issues. Given my own scientific background, this might seem like the most reasonable approach. However, I have specifically decided to focus on personal experience, to recognize the unique path that each of us has taken, and to allow our collective biographies to highlight the turning points, encounters, choices, and drivers that have led us to choose and commit our lives to this hybrid career. Although these stories may help us understand what brought us to this highly specialized occupation, I sincerely hope that our personal experiences also move younger generations to seriously consider this spectacular profession. I trust this goal is shared by my co-authors.

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