Views & Reviews The Bigger Picture

All that glisters

BMJ 2009; 339 doi: (Published 14 September 2009) Cite this as: BMJ 2009;339:b3734
  1. Mary E Black, public health physician, Belgrade, Serbia
  1. drmaryblack{at}

    The doctor sat in front of a computer, concentrating hard as she considered how to explain a two year gap in her CV. Nothing unusual there, you might think. Many of us take career breaks, but this doctor’s illegal migration in search of a job in western Europe had gone badly wrong, and she had been trafficked and forced to have sex with 10 or more men a night while her young daughter waited without news in Moldova. I met her while helping organise entrepreneurship training for trafficked women in Belgrade.

    I was idealistic when I applied to medical school. The smartest girl in my class, I wanted to save the world (more specifically Africa), have an interesting life, and never have to compromise my principles in a war, as I figured they will always need doctors. I assumed that doctors were an honourable, influential, and prestigious group and never imagined having to beg, scrape, or live at the margins of society.

    Since those naive days I have met all kinds of doctors. Most would fall into the successful, generally happy, fulfilled, and economically secure category. I have also met others for whom the glittering dream went sour. This includes a few doctors struggling with addiction to morphine, and many more who are alcoholic, and doctors with careers cut in half by a ruinous court case or haunted by a past tragedy on the table. I know doctors who have been killed or injured by their patients. I have spoken with doctors who provided advice on the interrogation of prisoners or enemy combatants; the interrogation sounded more like torture to me. We all know doctors whose relationships did not survive a punishing on-call schedule and colleagues who have been bullied at work. Some doctors are corrupt, and some are incompetent, others nasty. And doctors migrate all the time—those of us who were fortunate and had a choice moved for a better opportunity. But there are also doctors working as taxi drivers and cleaners far from home, trying to send money back to their children.

    This is the season of medical school hopefuls, those with straight As heading for the home run with chirpy letters asking for a two week attachment likely to help their application. Medicine is indeed a noble calling, but perhaps we should also tell applicants that it is strenuous and complex and challenges you at all levels. Doctors are not automatically loved and respected. You will have a higher risk of suicide and will at times be scared and shocked. Being a doctor does not confer protection from life’s dark corners; for some it will not even guarantee economic security.

    The idol has clay feet, and cracks.


    Cite this as: BMJ 2009;339:b3734

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