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Medical vocation in the 21st century: "death or resurrection"
Vocación médica en el siglo XXI: "muerte o resurrección"
Daniel Alejandro Vera-Rivero1* https://orcid.org/0000-0001-8807-0211
Nubia Blanco-Barbeito2 https://orcid.org/0000-0002-0359-9157
1 Villa Clara University of Medical Sciences. "Arnaldo Milián Castro" clinical surgical
University Hospital. Villa Clara. Cuba.
2 Villa Clara University of Medical Sciences. Medical Sciences Faculty . Sagua la Grande.
Villa Clara. Cuba.
*Author for correspondence. E-mail: dverarivero@gmail.com
Submitted: 05/12/2018
Accepted: 17/04/2019
To the editor:
Interpreting the historic article by Professor Fidel Ilizástigui Dupuy "The clinical method: death and resurrection",(1) the authors of this letter set out to discern about a matter of such ethical, human and social commitment as it´s the medical vocation of the students of Medicine in the contemporary world, and specifically in Cuba.
Medicine is one of the oldest professions, whose social and humanistic function gives it the highest degree of approximation to the existence of the human being; however, it is currently suffering the onslaught of various influences, particularly economic, which affect the essence of this professional practice. The commercialism of medical resources and services, the sensationalistic press, lawsuit-hunting lawyers, "unfounded" claims for medical errors, create a context of an increasingly privatized, bureaucratized and frustrating Medicine that is detrimental to the vocational principle of its practice.(1)
Certain voices warn that in addition to considering the academic performance of the applicant to practice Medicine -which implies a long training and acquisition of scientific knowledge and professional skills-, the quality of their vocation and personal qualities should be evaluated, due to the responsibilities inherent to such profession.(2)
Several questions emerge around the medical vocation in today's world: is it born with it? Does university education contribute to its development? Are we obliged to feel a vocation if it is not "evaluated" in any exam? These questions do not have, as far as we have been able to review, precise answers. Most of the explanations formulated usually depend on the expert opinion of notable physicians who seriously thought about the subject, although without adhering, in a strict sense, to the demands of the scientific method.(3)
The dictionary of the Spanish language defines vocation as: "… inclination to a state, a profession or a career". A wide range of personal characteristics are attributed to it, by virtue of which an individual expresses a greater affinity for exercising a certain profession in respect to another.(4) The vocation is developed at the core of a complex web of experiences in which, in a singular way, biological, psychosocial and cultural aspects are interwoven. Therefore, knowing how this "inclination" crystallizes in the individual, perhaps it will always remain enigmatic.
There is no doubt that the training stage contributes to "shaping" the medical vocation. In the development of this teaching-learning process, there will always be a relationship of interdependence between the formation of knowledge and skills, and the formation of values, tastes, feelings, aspirations, interests and ideals that are materialized in professional and human attitudes.(5)
In Cuba, this issue is occupying more and more space in the academic debate, mainly motivated by the continued increase in the massive entrance to medical sciences degrees. This forces us to prevent trends or particular motivations that are not in accordance with the values, principles and human commitment that characterize the practice of the profession in our country. This is corroborated by Herrera Moya et al.(6) in their research, where in the opinion of the authors, motivation for the profession did not respond to qualities defined as altruistic, which are required to exercise it. Several of the students surveyed were oriented by extrinsic reasons: tradition of doctors in the family, fulfilling missions in other countries and economic possibilities.
The study of the medical vocation as a scientific problem then arises as a priority, since the student who does not have a consolidated vocation on moral values will be an easy hostage to a professional market that threatens to corrupt the human essence of the medical profession. It is precisely here where the university plays a fundamental role, through vocational guidance work, as other authors report, this is understood as a process that takes place throughout the person´s life, it begins since the earliest ages and it extends to the first years of its professional life.(7)
After these reflections and in search of a slogan that could perhaps explain the vocation of being a doctor; knowing the difficulty involved, we find the following phrase in the pieces of advice of Aesculapius: "You will see yourself alone in your sadness, alone in your studies, alone in the midst of human selfishness. You won't even find support among the doctors, who wage a silent war out of interest or pride. Only the consciousness of alleviating ills can sustain you in your fatigue. Think while you are on time; but if indifferent to fortune, to the pleasures of youth; if knowing that you will see yourself alone among the human beasts, you have a stoic enough soul to satisfy yourself with the duty you fulfill without hope; if you consider yourself well paid with the joy of a mother, with a smiling face because it´s not suffering from the disease, or with the peace of a dying person to whom you have hidden out its imminent death; if you long to know man, penetrate the misfortunes of its destiny, be a doctor, my son".(8)
BIBLIOGRAPHIC REFERENCES
1. lizástigui Dupuy F. El método clínico: muerte y resurrección. Educ Med Super [Internet]. 2000 [citado 24/112018];14(2):[aprox. 18 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21412000000200001&lng=es&nrm=iso&tlng=es
2. Perales A, Sánchez E, Mendoza A, Huamaní C. Vocación médica en estudiantes de medicina de una universidad peruana. An Fac Med [Internet]. 2014 [citado 05/12/2018];75(1):[aprox. 6 p.]. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1025-55832014000100007&lng=es
3. Wong A, Trollope-Kumar K. Reflections: An inquiry into medical students' professional identity formation. Med Educ [Internet]. 2014 [citado 26/11/2018];48(5):[aprox. 13 p.]. Disponible en: https://onlinelibrary.wiley.com/doi/pdf/10.1111/medu.12382
4. Diccionario de la Lengua Española. Versión 23. 1 [Internet]. 2010 [actualizado 2017; citado 19/11/2018.]. Disponible en: http://dle.rae.es
5. Cardozo Castellano R, Loaiza Borges L, Guevara Rivas H, Ortunio Calabres M, Sánchez Pilimur K. La motivación de los estudiantes de medicina de la Universidad de Carabobo. Una aproximación teórica. Comunidad y Salud [Internet]. 2010 [citado 27/11/2018];8(1):[aprox. 9 p.]. Disponible en: http://www.scielo.org.ve/scielo.php?script=sci_arttext&pid=S1690-32932010000100004
6. Herrera Moya VA, Alfonso Tejeda I, Quintana Uguando M, Pérez Inéranty M, Navarro Aguirre L, Sosa Fleites IM. Formación vocacional y motivación: su incidencia en el estudio de la carrera de Medicina. EDUMECENTRO [Internet]. 2018 [citado 27/11/2018];10(2):[aprox. 14 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2077-28742018000200009
7. Vicente-Sánchez B, Vicente-Pena E, Rocha-Vázquez M, Costa-Cruz M. Orientación y formación vocacional hacia la carrera de Medicina. Medisur [Internet]. 2014 [citado 26/11/2018];12(1):[aprox. 14 p.]. Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/2725
8. Esculapio. Consejos de Esculapio a su hijo. Bioéticaweb [en línea]. Roma, Italia: Pontificia Università della Santa Croce. [Actualizado 01/2001; citado 24/11/2018]. Disponible en: https://www.bioeticaweb.com/los-consejos-de-esculapio/
Declaration of interests
The authors declare no conflict of interest
Contribution of the authors
Both authors participated in the conception of the idea, bibliographic review and elaboration of the article.
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