Don't Become a Doctor #12 - Limited resources

One of the main principles of medical ethics is something called distributive justice. What it means is that resources should be allocated as fairly as possible, and when resources are limited, they should be aimed towards bringing the greatest benefit for all, not some.

When students think about distributive justice, they often call to mind health care expenditures and waiting lists for specialists. They think of MRI's and other expensive tests. It is a little detached, but the truth is that distributive justice is a harsh reality in medical care.

The easiest example is mass casualty situations. The first rule of triage is treat who you can save. If you can't save them, then don't waste your resources. It's cold, but it's society's competing interest.

But you don't have to have a mass casualty to find limitations in resources. I have been in a lot of tough situations as a resident. I've had a full ICU and patients needing a unit bed. I've had simultaneous codes. I've had three patients all go into respiratory failure at the same time. There are a lot of tough choices to be made there.

Now, most non-medical folks cringe to hear things like that. 'We need more nurses' or more financial support, or more beds, or whatever else. They mean well, but they miss the point. There will always be limits, but the most precious resource isn't any of those things. As a physician, I am the limited resource. My attention is a valuable commodity, and how I allocate it can be the difference in who lives and who dies. That is a tough call to make, and if you want to be a doctor, it's a call you'll have to make.


Phil said...

Hey man,

I've read through your blog on and off for the past year and a half and what struck me the most(other than the great medical content) were your posts about relationship difficulties, shyness, etc. I can relate so well because I faced the same issues in my teens and have only made real progress in the last few months. If I can offer advice without being too intrusive, I'd say that most shyness issues basically come down to accepting everything about oneself, including every flaw(sounds cheesy, I know) and then taking massive action to get what you want. This site ( explains this stuff in a new light, and even if some of the advice seems sort of crazy, it's well worth the read. I hope you enjoy it and best of luck with everything!

Craig said...

Hey. I just discovered your blog today, and I just wanted to say 'keep it up!' I'm a 30-year-old web designer, and I'm trying desperately to pay off some debt so I can go to med school. It's been really encouraging reading through your blog and seeing what the day-to-day is like. Keep posting!

E said...

great post. we are indeed a limited resource.

Dragonfly said...

Good post.

Anonymous said...

With your post in mind, I was wondering if you might share your opinions on the current medical school admissions standards. As it stands, most applicants will not gain admittance into ANY school of medicine; there is also an impending crunch on residency spots.

How do you feel about this limitation on the supply of doctors? As such a valued and limited resource, can/should society find ways to increase the flow of physicians?