Did you ever go to a career counselor in college?  In Medical School?  How about High School?  How did it go?  Did it help you make any decisions?  To pick a profession – maybe decide between Nursing and Medicine?

When I started to think about career counseling in the setting of this film, How-To, I didn’t recall ever seeing a career counselor, not in my entire life.  But then I thought about it.  Pretty much all of us had mandatory meetings with our high school guidance counselors.  Mine told me that I could wait until after Christmas to get my college applications in.  If I had paid any attention to him, I would have missed the deadline for Harvard, and I’d have had to flunk out of a State school instead of an Ivy League college.  And I vaguely remember taking some aptitude tests along the way – I didn’t really pay attention at all, though.

How about in college?  Well, we had assigned Pre-Med advisers.  I knew very, very little about what I might be getting into.  My advisor, David Scadden, MD, couldn’t really fix that.  I didn’t really understand what medicine in general was about, nor what different specialties and practice settings entailed, until well into my first residency.  My advisor did do a great job of helping me prepare my applications, and helped me adress my checkered past – I had flunked out, after all – head on.  He suggested that I get some volunteer experience, prompting me to work for a time with a Boston AIDS activism group.  This turned out to be a wonderful seed – it led me to volunteer at the Haight Ashbury Free Medical Clinic during most of Med School.  This was a watershed for me – it led me to grow a social conscience, to love clinical medicine, and to work hard on things that matter.  Unrecognized by either of us, he turned out to be one of the most important influences on my entire life!

My Medical School didn’t involve any career counseling, but OHSU, where I am a faculty member now, has built  career counseling into the curriculum.  It is based on the AAMC Careers in Medicine program, a package of materials and support services that helps medical schools develop a program to help medical students make career choices. AT OHSU, at least, this includes some didactic material, taking the Myers Briggs personality test (a free version is here, another here), and some small group meetings.  There are always a few students who know exactly where they are going – the woman who has wanted to hammer and saw bones since she broke her leg skiing in 7th grade, or the young man who has done research for many years, with Med School and residency a regrettably necessary detour from their main business.  For most of us, though, we feel buffeted by the possibilities.

If a student is really floundering, he can easily get extra counseling, either through the Dean’s Office or by seeking out faculty mentorship – if he has the nerve.

Most clinicians (Physicians, PAs, Nurse Practitioners and other Advanced Practice Nurses, along with nurses, and RTs, and. everyone delivering patient care) say that they didn’t really know what they were getting into with a career in health care.  The pressures, the tragedies we see – it changes us in mysterious and unforeseen ways. How-To is about weathering those changes with your self intact.  In part, I hope it will help students facing career choices – like the whopper of them all, what specialty to go into – as well as provide guidance and inspiration to those who’ve already landed somewhere in the real world of our medical-industrial complex.

If you have advice for the filmmaker, please write or leave comments!  More to follow…