What Motivates the Doctor?

The Plague by Albert Camus tells the story of Rieux, who serves as presiding doctor over a small north-African town as it is struck by a deadly plague.  The plague “shuffles the cards,” as one townsperson puts it; wealth, status and occupation spare no one.  As the town is quarantined and daily life grinds to a halt, Rieux and his closest friends are forced to reevaluate their understanding of their position and purpose within their community and on this earth.  Addressing his friend Rambert, a journalist who got trapped in the town by mistake, Rieux says:

‘But I have to tell you this: this whole thing is not about heroism. It’s about decency. It may seem a ridiculous idea, but the only way to fight the plague is with decency.’

‘What is decency?’ Rambert asked, suddenly serious.

‘In general, I can’t say, but in my case I know that it consists in doing my job.’

The plague of Florence (1348)

The plague of Florence (1348) as described in Bocaccio’s Decameron

Rieux knows that he can’t single-handedly beat the plague.  He knows that the plague may not be beatable.  Yet he’s no longer concerned with acts of heroism such as these.  Instead, Rieux holds on to just one basic concept: that of duty.  It’s his duty to heal, and Rieux will continue to do so even as the world falls apart around him.  Rieux heals, simply because it’s the right thing to do.  It may not be heroic, but it’s decent.

The Plague struck a chord with me, as recently I’ve begun to finalize my decision to pursue medicine.  When I was younger, my goals were more idealistic–more heroic, perhaps.  I looked back on the greatest triumphs of scientific research–Salk’s polio vaccine, the discovery of the double helix, and so on–and wanted to write my own chapter in the history of science.  I even wrote my college essay on my hero, Charles Darwin, who devised his revolutionary theory while on an expedition intended to study barnacles.  Lately, however, I suppose my goals have decreased in scope.  I’ve chosen a career which I know will save a few lives, but which almost certainly will not change thousands.  It’s the “sacrifice of the physician,” as I call it.

I recently talked about this with Dr. Krieger, a neurosurgeon at Children’s Hospital LA.  I told him that, while noble, his career probably wouldn’t make a longterm difference.  To this, he replied, “Well, did Watson and Crick make a difference? Depending on your degree of nihilism, no one makes a difference.”  According to his argument, nothing is absolute, so you might as well choose a career with a guaranteed reward.  Better to be sure to change one life than to attempt to save many while risking saving none.  I may not change science, but if I change one life for the better, that should be enough reward for me.

I argue that he who saves but one life, especially while making the physician’s sacrifice, is not merely decent, but is indeed heroic.

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5 comments on “What Motivates the Doctor?

  1. Ben says:

    I disagree that Rieux heals because of duty. Camus’ philosophy as a whole, in fact, seems quite antithetical to the idea of duty! Where could Duty fit into Camus’ world of vast, sublime indifference?

    Rieux heals, I believe, because his trademark “resigned indifference” leaves him with no other option. He lacks the fiery opportunism of Rambert and the ideological devotion of Tarrou. His happiness arises from serene acceptance of the absurd contingencies of the world; to demand a reason in the first place would be to violate his characteristic philosophy.

    One final note: why resign yourself to obscurity? A safe bet is not always better than a long shot. Pursue an MD-PhD.

  2. Richard says:

    Not much clarity is gained about what Josh considers heroic, other than in the conclusion where it’s sufficient for heroism that one make the ‘physicians sacrifice’. Some reference to pioneering work in the life and health sciences is also made, which helps give a better idea of the ‘heroism’ Josh has in mind. But, on the negative side, insofar as this entry reads as a moralizing one, Josh would have done well to consider that his notion of sacrifice is at best a ‘relative’ one. If one has the privileges required to get into academic research in the first place, then it is indeed a variety of sacrifice to discard that sheltered lifestyle for the more practical ‘field position’ of a physician. However, given that (a) considerable privilege relative to global standards of average wealth and education opportunities are needed to enter medical school in the first place and (b) even among the socially elite medicine is a sought-after and lucrative field, the word ‘sacrifice’ to describe the decision to enter medical school begins to look a bit misguided.

    The distinction between decency and heroism starts to fade in the end of this post; rightly, in my view. Also, the former association of heroism with academic excellence in research raises an interesting parallel with a well-known paradox in Rational Decision Theory, at least as far as Josh’s decision is between being a physician and being a pioneering scientist. The paradox is called ‘Allais Paradox’, you’ve probably come across it before (as suggested by your comment that a safe bet is not always better than a long shot). Applied to this scenario it involves Josh choosing an action with a high probability of yielding results with moderate utility (i.e. saving quite a few lives) over an action with low probability of yielding results with very high utility (e.g. revolutionising science and human society). If Josh’s medical career has a 100% chance of yielding something with utility x and his scientific career has a mere 1% chance of yielding something with utility y, then even if y is much, much bigger than x and so the expected utility of choosing the scientific career is greater than that of choosing the medical one, the paradox tells us that Josh is still going to choose the latter. Which he has.

    • Ben says:

      Though a very rare scientist might revolutionize his/her field, a doctor still is, all things considered, much more likely to be acclaimed and recognized, at least by a moderately large circle, than is a researcher. Rather than as one between sacrifice and heroism, we’d be better to characterize the choice as between likely moderate heroism and unlikely extreme heroism. If you’re risk-averse, you’d prefer the former.

      Which brings me to Allais’ paradox. If I understand the paradox correctly, then risk aversion — namely, the phenomenon whereby marginal utility per dollar decreases as dollars increase — is alone sufficient to explain the paradox. That might be what’s going on here.

    • Josh says:

      I agree that a lot of this post is pretty silly. Still, the points I brought up yield some decent discussion points, including Allais’ paradox, which seems apt.

      For what it’s worth, I’m still highly involved with research, so I haven’t yet given up the possibility of affecting thousands, not just hundreds. But I forgot if that makes me heroic or not. Haha

    • Josh says:

      Addressing this more seriously:

      Allais’ paradox addresses the utility of decisions. What in particular is it that we consider to be utile?

      If it’s helping people, then Allais’ paradox applies well. We have a 1% chance of helping tons of people, vs. a 100% chance of helping a moderate amount of people.

      Unfortunately for me, the probability distribution is probably roughly similar for heroism, to Ben’s point. So, it would be hard for me to deflect allegations that I chose medicine for this reason.

      On that note, is the distinction between these as clear as we’d like it to be? It feels good to run into a burning building and save people, and to be recognized as a hero afterwards, since this recognition is evidence that we have been altruistic, a recognition that we have likely evolved to pursue.

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