September 2003

The Enemy Within

By Michael J. Katin, MD

"How sharper than a serpent's tooth it is to have a thankless child." Shakespeare, King Lear, Act I, Scene iv.

It has now been just over 12 years since the failure of the "August coup" in which residual hard-line believers in the Soviet system tried to take over control of the government from Mikhail Gorbachev, and the fallout from this event led to the dismantling of the power of the Communist Party. Almost overnight the balance of terror under which we had lived for over 40 years had vanished, and the opportunity for world peace suddenly presented itself as a realistic possibility.

Fortunately, humanity came to its senses and we are now overwhelmed by multiple varieties of internecine strife, with danger from nationality/ethnic/religious groups that had not been known to exist prior to 1991. To make matters even worse, we in the medical profession are now threatened by an insatiable, cunning, and merciless hoarde: our offspring.

There is a tradition in businesses to hand over the family enterprise to the next generation (G.P. Putnam's Sons, the Von Trapp Family, Sanford and Son, the British Empire, etc.) but this is a vanishing tradition in medicine. Handing over of the family practice (even if it isn't Family Practice) is impossible if the next generation doesn't think it's a good idea to go into the medical profession. For the past six years, applications to medical schools have decreased, with stablization finally this year. That would be bad enough, but applications to law school have gone up 21% in one year and MBA degrees are being pursued in record numbers.

Traditionally, the medical field was seen as a respectable profession reflecting accomplishment in our society, and medical schools were filled by children of immigrants and also by scions of established families who had wanted to leave the sterile world of business and work with flesh and blood (e.g., Howard Dean). The 1954 book Not As a Stranger, by Morton Thompson (published, interestingly, by Charles Scribner's Sons, indicating that publishers are much more successful in controlling their children), described a medical school class made up of this variety; imagine that in the 1955 motion picture (the first directed by Stanley Kramer) some of these students were played by Robert Mitchum, Frank Sinatra, and Lee Marvin. I don't know who played Howard Dean.

There are at least three reasons why our children don't want to go into medicine:

  1. Fear of SARS
  2. Fear of working hard
  3. Fear of poverty

Once they get past these restrictions, there's also the example of their contemporaries getting out into the real world years earlier, although at least now the guarantee of outrageous salaries is temporarily on hold. It will probably be at least 3 more years before the investing public is willing to pour zillions of dollars into fly-by-night tech companies with no products.

Although most of us would prefer to see our children go into medicine because of the example we have set for them, they've also heard us complain incessantly about how businesspersons and lawyers have ruined our ability to practice. It's therefore somewhat ironic that every day I hear one of my colleagues speaking of his daughter or son who just got accepted to law school or business school.

Mythology has it that the pelican feeds its young by piercing its breast to release its own blood to them. This is depicted on the official state seal of Louisiana, although there is no official state pelican that depicts a seal as doing the same thing. Regardless, this was thought to be fact by the ancient Romans, who also believed that flies came out of rotten meat, that Iraq had weapons of mass destruction, and that the earth was the center of the universe.

In other words, we work endless hours at our profession to try to create a secure and nurturing environment for our children, at which point they turn on us and go into the professions that plague us the most. Is there a self-destructive mindset in our families that creates this? Are we planting the seeds of our own destruction, so to speak? This makes King Lear look like Ward Cleaver in comparison to our situation.

Maybe this is part of the circle of life, and the next generation beyond will consist entirely of orthopedists and nephrologists. In the meantime, we'll continue to support our children, maybe not as dramatically as the mythological pelican. Regardless, even if we don't give them our blood, they'll be giving us their bills.

email: mkatin@radiotherapy.com