Tuesday, February 24, 2009

Medical School is Just OK

“How’s medical school going?” That’s a common question, and I don’t think I have the most cheerful answer. Maybe my bitter honest sentiments were strengthened by living in Ukraine- where one never responds to an inquiry with “Great!” or “Good.” I can’t bring myself to respond that medical school is “cool” or “amazing.” The best word that comes to mind lately is “ok.”

Yes, just ok. Why just ok? Well, has anyone ever told you that medical school was the best time of their life? I doubt it. That’s because it’s really pretty hard. Medical school hard- that’s no surprise, right? It seems that many medical students must be a special breed of people that thrive on academic torture as much as helping others. Indeed, there has to be a high level of willingness to sacrifice, delay gratification, and self-discipline for students in this odd regime, and it’s no cheerful matter.

The US medical education system is undoubtedly an “odd” thing to take part in. First of all, there are the prerequisites and admissions—basic science classes, the dreaded $250+ MCAT, the expense of submitting an AMCAS online application, and the drawn out selection process which can last from June of one year until August of the following year. It’s a self-selecting process that fills all applicants with self-doubt, and often a competitive mindset. Is this what it takes to become a recognized, practicing healer in our country? Being a basic science wiz, having a lot of money, and knowing how to get ahead of others? What about kindness or compassion?

I recently read an article, “Most Likely to Succeed“ in the December 2008 New Yorker magazine in which Michael Gladwell explores how difficult and unpredictable the NFL quarterback selection process has been. He writes, “There are certain jobs where almost nothing you can learn about candidates before they start predicts how they’ll do once they’re hired.” He goes on to make a connection to medical admissions saying, “We now realize that being a good doctor requires the ability to communicate, listen, and empathize—and so there is increasing pressure on medical schools to pay attention to interpersonal skills as well as to test scores. We can have better physicians if we’re just smarter about how we choose medical-school students.”

It’s true—there is a new movement in medical education to select people who have done community service, and who show dedication to humanitarianism in their essay and interviews. In fact, I think this is probably the reason that I was accepted to medical school. Yet, most schools continue to value the test scores and basic sciences just as highly as humanistic skills.

The result is that I am surrounded by amazing people- who I deeply admire—but who also happen to have trouble breaking out of the competitive and over-achieving mindset. I occasionally am drowned by this sentiment myself. For example, after a recent exam, I found myself unable to hold back tears. Meanwhile, I made myself feel worse because logically I knew how stupid it was for me to be crying over my grades. I know that as life challenges go—this one is not so bad.

For most people I study with, it seems being in medical school is the most important part of their lives. What’s the problem with that? Well, maybe nothing if you think that Dr. House is the best doctor ever. Personally, I’d prefer a well-balanced doctor who cared about me—even if it meant delaying the right diagnosis. But I think many Americans might choose the cynical, distant, and brilliant physician, if they had a choice.

This past month of rigorous anatomy, physiology, development, physical diagnosis, and pathology—has not given me much time to ponder about my solutions to choosing good future physicians. I briefly considered using “shoe-selection” as a qualification (those wearing practical, but professional shoes during their interview would receive high marks in this category). However, ultimately changing future physicians would require a change in curriculum as well as admissions.

I would change the amount of basic science material covered to include less of these sciences, and more classes about public health, social work, and practical skills. I would also have less multiple-choice testing, and more options to extend medical school to 5-6 years, instead of just 4. I would try to admit some regular achievers along with the high achievers, out of which more people might be satisfied with general medicine rather than the highest specialty possible (although some argue that students choose specialties for the salary, maybe it has to do with personalities). Medical students currently are not the type to be satisfied with anything less than the best, most, and highest they can be- which is causing a huge shortage in primary care and family doctors.

My medical school is even supposedly non-competitive, and encourages the importance of listening and personal connection more than other schools. I am especially honored to be surrounded by many great physician role-models who act differently from most medical norms. My recent family practice mentor challenged my notions of American doctors by being extremely personal—making jokes and always hugging people when appropriate. She was so gifted, and developed a deep bond with patients—one that I dream of having someday too.

Yet, my days as a first year are normally so far removed from this type of experience. This semester has been more fulfilling than last one with anatomy and physical diagnosis being more hands-on and interactive than my previous courses. However, I am still bogged down by the exams, especially tonight. And I must remind myself constantly—like a mantra—that two years of classroom time is nothing compared to a career full of clinical joy, and the opportunity to get deeply involved in people’s health—something that’s special and sacred work. And maybe… just maybe… I will hold on to some sense of happiness, balance, and idealism, even if medical school is just ok.


ruxton said...

I think the climate of medical school is a subject that is undervalued and exceptionally crucial. I have been having problems with the medical profession lately based on my observation that doctors, for the most part, don't know how to let it be. Years of expensive schooling and rigorous competition tends to remove the age-old saying "If it ain't broke don't fix is." Most people would do well just hearing "Eat well, get plenty of rest, don't stress out, and you'll be okay," but that hardly justifies the medical school investment.

This was extremely prevalent when we were having our second child. My wife's pregnancy went late, in fact two weeks late to the day. All throughout those last two weeks we had countless medical professionals try to encourage induction. One doctor flat out said "We see a substantial increase in still births if the mother is not induced after her due date has passed." What is substantial? If you consider all of the babies born in a day even 1% is substantial. My wife was a champion and said "The baby is not ready to come out, we're not inducing." We took a non-stress test and a fluids test. The doctor ended up quitting after the first quadrant of my wife's uterus alone had enough amniotic fluid to sustain the baby for another week. We kept holding the doctors off and sure enough Amelia came out when she was ready. In fact, Amelia came out in one contraction, four pushes. A far cry from our son who came 27 hours after my wife had her membranes swept.

I mean, we're just kids who read a lot on the internet and have a pretty intuitive philosophy: if humans are so inept we wouldn't have made it 12,000 years. Still, in both of Steph's pregnancies we were better off without the doctors. Not because they were stupid, but because they couldn't just shut up and let it be.

Liz said...

Ruxton, I too was surprised to learn that the current medical recommendation is to induce labor before 2 weeks past due date! And without saying- that induction is to occur on a weekday during business hours (hmmm... sounds like a good way to make things easier for hospitals). Your wife is a star for speaking up for her desires, and advocating for herself. I have been surprised how many women DO want to be induced and DO want drugs. All this scientific medical training doesn't allow much space for intuition or the idea that maybe... people are different, and many understand their bodies better than a doctor. You should post something about birth in this country- that's a topic I'd love to discuss more. I don't think the US medical system knows how to handle birthing well- our infant mortality rates and other statistics are pretty bad.

Zach Wallmark said...

It strikes me that there is a bit of paradox at work in how doctors are trained and what patients want from their physicians. On one hand, people want a doctor who can empathize, who is warm and compassionate and communicates in a clear, reassuring language. This is the aspect of a doctor that Gladwell is referring to in his New Yorker article - a healer, not just a technician of the human body. From everything I've read, many med schools are taking this idea to heart, bringing in more and more students with social skills, not just high MCAT scores. (Your suggestion to bring in more middle-level achievers is a very good one.) The percentage of women in med school is also climbing higher each year.

On the other hand, however, people want a doctor who is all-knowing, authoritative, and flawless. In other, words they want a God-like character in the examining room. In another recent New Yorker article, Atul Gowande cites surveys that show that a majority of patients would prefer a machine to a doctor if they felt the machine's diagnostic prowess was better than a human's. Patients, above all else, want their physicians to be accurate in their assessments. The God-like reverence that many people show to doctors, in turn, inflates a lot of egos in the profession (and in med school), leading to a more distant, cold, supercilious bedside manner.

We want our doctors to be both caring humans and cold calculating machines. With these contradictory values, I could see how medical school pulls one in two directions at once.

Blue-eyed wonder said...

Liz, you remind me of how liberating it was when I gave myself permission to admit to anyone who asked about my master's thesis research, "I kinda hate it." The idea of not being totally enthralled with every aspect of a project that, I, after all, had chosen felt ... well, whiny. But the parts of the research that I hated (and there were many) made the parts that I did love all the sweeter. And I think I was a little saner in the meanwhile (and certainly better at writing about it) for being able to look the truth of the whole thing in the eye. I hope you can have the same experience, at least in retrospect. Thanks for your post!

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