Sometimes Critical Thinking Is At Odds With Clinical Practice
Recently, I had a job interview for a position at a local nonprofit. Being a PA, the position I applied for was a bit of a non sequitur, so I wasn’t surprised when the president of the board (an MD) inquired as to why I left clinical practice. Was I planning on going back? she wanted to know.
As diplomatically as possible, I shared the reason why I left: the treatment philosophy of my previous employer was not aligned with my own. “Well, not all of medicine is like that,” she said. There was an edge to her voice, and I sensed a bit of defensiveness. “That’s true,” I conceded, and I left it at that.
When I left my job as a clinical PA, I did consider going into another speciality. I enjoyed caring for patients, and I’d worked hard to earn the privilege of practicing medicine. I wanted to be a good steward of my talents and skills, my training, and my ability as a PA to help people live happier, healthier lives. But was medicine as a whole helping people live happier, healthier lives? Aside from all the qualms I had about my first job, I was starting to ask unsettling questions about medicine in general. For example, To what extent are clinicians venturing beyond the bounds of evidence-based medicine? When is this warranted, and when is it not?
As I searched for another speciality that might be a better fit, I had the opportunity to shadow a PA who did inpatient pain management. I admired the way she was so present with the patients we rounded on that night, and how she did everything in her power to ensure they were as comfortable as possible. This included taking the time to get extra pillows for one patient and arranging them until she was more at ease.
Then, the PA asked the woman if she could give her a little ketamine. “It helps take the edge off,” she explained. The woman said ok, and the PA put in the order. I wasn’t familiar with the use of ketamine for analgesia, so the next day, I looked into the research on it. It seemed like this wasn’t an entirely uncommon practice, but it also wasn’t standard. As clinicians, of course we want to do everything we can to help relieve our patients’ suffering. Yet without well-powered randomized controlled trials, how can we know what is helping patients and what is actually causing more harm than good?
I didn’t go back to clinical practice, and I didn’t get the job at the nonprofit. Although some of the people I’ve interviewed with have gleaned that I have a strong moral compass, others have only seen the disillusionment. “You have a master’s degree,” the president of the board said pointedly. Was that disappointment in her voice, or disdain?
The problem is, all those years of education taught me to hone my critical thinking skills — but in the real world, I’ve repeatedly been expected to set those critical thinking skills aside. How might I find a job where critical thinking is valued, and independent thought is encouraged? How might I find a way to survive as someone who tends to swim upstream?