Thursday, August 27, 2009

Careers Most Likely to Make a Difference

I had a fascinating conversation with an M.D. soon to be Ph.D. in physics. One topic we discussed is whether he thought he'd make a bigger difference seeing patients or working on the the next generation of medical imaging machines.

He reminded me that many patients, even when facing death, refuse to change their lifestyle, even modestly: "Please, eat fewer cheeseburgers. Not none, just fewer." Yet most heart patients don't. Indeed that is consistent with the findings of famed cardiologist Dean Ornish.

That reminds me of my experience as a career counselor. Nearly 100% of my clients walk out of my office with a plan they like, believe in, and know they should implement. Yet many implement their plan minimally if at all. When they come back for a subsequent session, the problem is rarely that the plan wasn't good nor that they didn't know how to implement it. They just couldn't make themselves change.

So I'm wondering whether, on average, the people who end up making the biggest difference are not those in the so-called helping professions, especially counseling and psychotherapy--because those require people to change. Rather, the people who are more likely to make a big difference are those involved in developing new technological tools that help people without requiring them to change much: for example: a better cardiac stent, a better search engine, a TV instead of a radio, a more efficient car.

What do you think?


Anonymous said...


Please don't allow yourself to become too discouraged over what you feel you can accomplish as an advisor. While, as a expert, you're able to perceive the full extent and range of a client's potential and appreciate all the possibilities, sometimes the person you're attempting to counsel is limited by family and/or financial obligations or restricted by choices made years or even decades ago.

However, in keeping with the axiom that "the perfect is the enemy of the good", what may appear to you, as an expert, to be rather modest progress might in fact be, for your client, a monumental change. For example, let's say you happen to have as a client a customer service rep who came from a working-class family, married young, had a family himself, and for whom college was never a realistic option, not because of any lack of academic talent but rather because of life choices that were made. Although he was unable to fully follow your recommendation that he fully realize his considerable potential and obtain an advanced degree, he decided instead to obtain an AA degree, which enabled him to leave his customer service job and land a position as an entry-level lab technician for a leading biotechnology firm. Although he wasn't quite to go quite as far as his talent might have taken him, you did inspire him to make a substantial change consonant with both his talent and his circumstances; in my opinion, such as case should be counted an enormous success.

Whenever you're able to spark authentic self-awareness, which is the necessary condition to constructive change and self-evolution, I'd count that as a major victory. I'm one of your recent pro bono cases (you know, the crackpot wannabe political philosopher) and thought you could use some bucking up.

Anonymous said...

I think you're overlooking - and it's easy to overlook - the things that (say) the medical profession does and does well that don't require any change.

Setting bone fractures. Saving gunshot and other trauma victims. Vaccination, vaccination, vaccination again. Prescribing antibiotics.

In policy roles, setting standards for public water and air. (ie, very little chromium in the water, very little lead in the air.)

Here in the first world, we no longer expect to die of infectious disease. We expect to have a good chance to survive fires, explosions, blunt trauma and gunshots - and we do in fact have stunningly good outcomes on all of those.

We no longer tolerate lead poisoning. We're starting to get ready to move on mercury poisoning. (Hint: vaccines don't emit mercury by the ton, the way burning certain things does. Burning things is legal and hard to litigate, hence the focus by prominent injury attorneys on vaccines.)

The bar has been raised in the first world very high; the remaining things to work on are the hardest to deal with and in some ways they represent the least important medical issues.

Yes, they're important to us now because they are what's left, but it's important to remember where we came from, and what we're actually still protected from and rescued from every day.

But, seriously, a sixty year old dying of complications from diabetes, a 65 year old dying of cardiac arrest, a 68 year old dying of lung cancer or emphysema - all of these are people who may have had 20 or more years added to their life expectancy and have come to take that for granted.

I'm not knocking neat high-tech gear. It's pretty cool stuff. I'm hoping to point out what a level of success we're already at that we can think about investing in that gear. And also to observe that that success does require sustained effort.

bill said...

Hi, Marty,

This is a very thought-provoking post.

I think it depends on the personality traits of the particular individual.

In my case, I need to work on something meaningful in order to keep me motivated, and I need to see some tangible results in the short term. Therefore, I'd fit more into the doctor/career counselor mode.

I also know some people that they're willing to spend years to research something that could have huge impact. But, in the short-term, they might not see any tangible impact. These people are motivated to solve massive problem, and hopefully find a solution that will fundamentally change the world. I think your MD-turned-PHD client belongs to this category. I have a lot of respect for this type of person because they have the tenacity to persist for a long time without seeing any result.

I think our world needs both kind of people. It is not a black-and-white, or one way is better than the other way scenario.

Anonymous said...

I think people in the "helping" professions do make a positive difference in the world. Even if it doesn't seem as if many of the individuals they are trying to help are changing, they are helping to propagate memes that will eventually effect changes in society.

For example, I'm sure doctors began telling people to quit smoking long before smoking began to be looked down upon in this country. They may have not made much of an impact on people's behavior initially, but eventually opinion against smoking reached a critical mass and the media began to join in the effort and more and more people quit and now a lot less people ever smoke at all than in the past.

Michael Roenblum, M.D. said...

When it comes to our health, have we developed an entitlement mentality in the United States? So many health problems are related to lifestyle issues, but we continue destructive behaviors with the expectation that ever more complex technology will save us from the consequences of our actions. We even expect that expensive new technology will be paid for by someone else, through emplyer-based or government sponsored health insurance.

Perhaps the role of government should be limited to educational efforts, not the provision of entitlements. The first Surgeon General's Report on Smoking and Health, 1964, was a low budget effort but began to turn the tables on an epidemic of cigarette addiction in the U.S. The resultant reduction in smoking has been far more efficient in reducing disease than government-sponsored lung transplants for end-stage smoking damage.

In short, I think there is more of a potential in education to prevent problems, rather than high-tech interventions once the ravages of disease have developed.

Maureen said...

[To "crackpot": Like Marty would ever encourage someone to get an advanced degree when a lesser effort would do. But I guess that was just an example.]

You can't measure success by how much of the great plan they carry out, but by their increased sense of hope and empowerment / self-efficacy. People come into career counseling thinking there's no way in the world they'll ever figure out what they want to do - that everyone but them got the memo from God about what their life's work is supposed to be. It's all a random, disorganized mess. You give them a path, a process, a way out of the quagmire. That's worth gold.

You also listen them in a way no one else ever has about things they haven't discussed with anyone else. You praise them for things they've never been praised for. You give them permission to have pride about things they weren't sure it was okay to be proud about. Or things they didn't even know about themselves. How many people say, "Wow, I never __ before. Thank you so much"? That's worth gold, too.

They DO change - you just don't always get to see it. You never know how much you affect people - even years down the road. Before you get skeptical, think of all the tiny things your father said or did that are still with you.

Anonymous said...

Good point Marueen - the example I attempted to construct (first posting) was rather ill-considered, particularly given Marty's extensive writings illustrating how formal advanced education can sometimes be of dubious benefit.

What I was hoping to demonstrate was how even a client's imperfect or partial implementation of a brilliant plan can still represent a monumental step forward and be counted as a major success. Sometimes obstacles can't be fully overcome - but they can be acknowledged and accommodated.

I also like your point about how insights offered today can profoundly affect someone many years later.

Maureen Nelson said...

I just got the latest issue of The Mentor News in my inbox, produced by Rey Carr. In the article "Short-Term Mentors Lead to Long-Term Results," he writes:

"We often think of mentoring as a relatively long-term relationship where the two people involved get to know each other more deeply over the period of the mentorship. Indeed, this has been the case with most of the mentoring relationships with which I've been involved.

Yet there are times when the mentoring was short-term or even occurred as a one-time meeting. I know this is the case because it has happened to me on more than one occasion. And that one time meeting not only accelerated my learning faster than I might have been able to accomplish on my own, but it also had a significant impact on my life for years afterwards."

He then goes on to relate how his one-time meeting with Walt Disney changed his perspective. I think people in the helping professions have an opportunity to be a "Walt Disney" for others. We just need to act with integrity, put our clients/ patients/ customers first, be continually open to vision and new perspectives ourselves and pass on that vision to others. (And that includes challenging people and giving them tough love when needed.) Again, you'll rarely hear "the rest of the story" -- you just have to trust that you made a positive impact. But don't underestimate the power of the one-time meeting.