Tuesday, June 9, 2015

From Dope to Genius in Three Short Years?

how most of us think we'll look on our first day of internship

the reality of how most of us will actually look on that first day if we're fortunate enough to get there

All this studying and taking of tests has caused me to wax philosophical to some degree. Not too much, because my brain is too fried to think thoughts much deeper than the Sacramento River at its source, which in this especially dry year, is not all that deep. The statistics that have been quoted to me are that 85% of us who make it through finals and are invited back will ultimately make it through either this program or another medical school program and will eventually be physicians or surgeons or both.(Note: That doesn't mean that 85% of us will make it through finals and be invited back. The percentage if the class that will still be together is closer to 80%. But of those 80% who are invited back, 85% of us will make it through a medical school program. If we want to get into really high mathematics here [ sarcasm font], it rounds out to nearly 81 of us surviving the initial cut, then 69 of us ultimately surviving some medical program somewhere.)

I looked at the statistics graduating classes of the last three years.  Each year over 90% made it past the first year, and over 90% graduated from an accredited school (87% on average from here). I also looked at last year's entering class, which still has 95% of its original enrollees. Either the staff quoting these statistics to us thinks we're stupider than any class in recent history, or they're bullshitting us with scare tactics, or both. I suspect we may lose a few classmates but not more than five.

As I visualize the people I saw picking up and turning in their final exams  yesterday morning, it gives me cause for concern. Even as I visualize myself among the others, it does little to alleviate my concerns. We'll all have another year of intense class work, followed by a year of clerkships (relatively intense 3-week blocks of working in particular specialties, at which time we should be exposed to enough branches of medicine that A) we should be able to handle routine cases in most fields of medicine well enough to keep a patient alive until someone smarter than we are arrives on the scene and B) we should have a decent grasp as to what area of medicine in which we desire to specialize. Not everyone gets his or her first choice, but there are enough different specialties out there that everyone should be able to find an area of specialty with which both he/she is suitable and is suitable to both him/her. If it doesn't work out on the first try, one can also take additional courses to make one more qualified and try again for a desired specialty the next year. Also, a graduating medical student can complete a general internship virtually anywhere, and then apply for a residency in a specific area for the next year.

I just don't see how we can make it from point B, where we currently are, to Point E, which is having passed the courses, tests, and various checkpoints necessary to qualify us as M.D.s. We won't yet be licensed physicians. That doesn't happen until after an internship and successful passage of an exam.

Sometimes I think I see the same feeling of doubt I'm feeling on the faces of a few of the professors staring at us during lectures. Maybe I'm misreading their expressions, or maybe they've showed those same expressions to every cohort who has come their way. Perhaps they're  merely trying to intimidate us. The possibilities are almost but not quite infinite.

The summation of it all is that we have three short years (minus this summer) to be ready to save patients' lives. There will be times when, at a given moment, whichever of us happens to be in the E.R. of whatever hospital at which we intern will be the most qualified person in the emergency room. If it's a really small program at which one of us serves his or her residency, that person could be the most qualified person in the entire freaking hospital in the late night/early morning hours. (I do NOT intend to intern with such a program. I intend to work where there is someone who knows more than I who is only a page away at all times until I've completed my year of internship and am a licensed physician.)

We have little more practical knowledge than does the average person who has passed CPR/Advanced First Aid in terms of saving the life of a person who is critically wounded or ill, yet in three short years we will be charged with saving lives in the E.R. If that is not daunting to myself or to any of my classmates, there is seriously something wrong with us.

Looking at my peers, some of whom are sitting in my living room as we take a brief break from studying for tomorrow's final, I wonder if they're feeling anything close to what I'm feeling. The time will come, I hope, when I feel ready to take on the world, or at least learn to do so. Right now, however,  I'm not feeling all that confident. I'm confident in regard to yesterday's final, tomorrow's final, and the practical exam on the following day. In terms of curing the world of all that ails it or of saving even a single critical patient, I'm feeling not particularly self-reliant. I think that is perhaps an appropriate way to feel now. 

All any of us in the cohort, including the very brightest, who are sitting right here in the room with me, should really know is just how much we don't know. My feeling is that the smartest of us know that. Those not quite so sharp may have a hint that such is the case. Those who have no idea how little we know are, I hope, the five  or twenty or twenty-one classmates, depending upon whose statistics one believes, who will not be with us next year. Medical school is not merely a process of teaching individuals to treat patients, but is also a process of culling those who cannot learn quickly and retain what they learn. With constant changes in research, knowledge bases, and even technology, when we graduate, we will not know even half of what we will need to know by the ends of our respective careers in order to have been successful in our fields. The importance of learning will not end for us at our graduation, at the completion of our internships, or at the culmination of our various residencies. In all fields, continuing education is important, but probably nowhere is it more important than in the field of medicine.

To every thing there is a season, and a time to every purpose under the heavens. For those of us finishing our first year of medical school, it is time for us, after a brief rest, to acknowledge just how much it is we have to learn, how very little time in which we have to learn it, and to get the job done any way we can.


  1. I think anyone capable of the deep thinking you have done in this post will get through med school just fine. Try to relax and enjoy it.

    1. I think I'll probably be OK. I even think Matthew will be OK, though ultimately that will have to be his problem. Still I'm very pessimistic by nature. Thinking of everything that could go wrong for me usually keeps those things from happening. In a rational sense I know that thinking negative thoughts doesn't control those things a person cannot control, but I believe it helps me to be especially meticulous in terms of anything that falls within my grasp.

  2. I like the saying that a thousand miles begins with one step. I read a book by a guy who went to Harvard Law School. He said that law has its own language. So it must be the same in medicine and so you cannot start out too fast. Also I say that in medicine, they do not have time to cure diseases since they are too busy coming up with new names for diseases like bipolar instead of manic depressive and polycystic ovary syndrome instead of polycystic ovarian syndrome.

    Then they have new ones like people getting juvenile diabetes very late having type 1.5 diabetes and people with Alzheimer's disease having type 3 diabetes.

    I can guarantee you that you are better than every medical doctor in the late 1800s. Their main method of treatment was bleeding or bloodletting. Here is a presidential treatment. George Washington had a very sore throat so his doctors bled 3 pints of blood from him and he died! Bleeding was so important to maintain good health, that you could go to your barber and get a good bloodletting.

    1. That is actually a consolation, chuck. I am better than George Washington's doctors. and he was the freaking POTUS.

      My mom, who is an educational and clinical psychologist, has a field day every time the powers that be decided a condition needs a new name or acronym. She told me about one of her last IEP meetings. It was for a very young child, whom the pychologist of record had evaluated. The diagnosis was "Intellectual Disability." the mother freaked out because she had wanted an autism diagnosis. A lady from the kid's public preschool program was trying to console her. She said to the mother, "It's not like they're saying he's retarded."

      My mom, the psychologist, and the special education teacher gave each other knowing glances. it would have been much easier, but unethical,, to say nothing and let the public preschool teacher's statement stand, and it was going to get ugly when someone clarified the matter, but it was something that someone could b=come back and sue the district for years down the road when the mother finally found out that "Intellectual Disability" is the new politcally correct term for what was formerly called "mentally retarded."

      my mom said she worded it as diplomatically as she could but explained that an intellectual disability was the current term given for a diagnosis for a child who displays cognitive and adaptive delays more than two standard deviations below the mean on at least one standardized cognitive test, with rating scales completed by parent and teacher demonstrating delays in adaptive skills as well. they got out of the meeting without being knifed or shot at, but barely.

      it's pointless. We all remember the terms moron, imbecile,and idiot, which were once clinical deascripotions for the three degrees of mental retardation. They were dropped when they became playground epithets. The same thing happened with "mental retardation." I'm told that in the 60's through 80's, the big thing was to call each other "M. R.s" Then it became retards (pronounced /REE-tards/ and sometimes just "tards." Eventually the Rosa's Law thing will catch on, and kids will call each other "I.D.s" or, if one of them has knowledge of the law that spawned the change, they may even start calling each other "Rosa" as an insult to each other's respective intelligence. Wouldn't THAT be ironic if the name of the child whose parents provided the impetus for the abolition of the term "mental retardation" and all its forms eventually itself became an epithet? All it takes is one kid to start it, and kids are more savvy than adults think. Kids could insult each other for the better part of a year using the name Rosa before teachers and supervising adults grew wise to the significance.

    2. Yup. I have vented about that a few times myself. New names don't change conditions... they only add to the arsenal of playground insults. That's why I refuse to stop using the word "retard". It has perfectly good uses besides the potentially hurtful one.

    3. What would you say if someone called you a "sawcy pedantique wretch"? This was considered an insult in the late 16th century ... and the world spins madly on :)

    4. I use "retard" as a verb but not really as a noun,although i won't say I never have. "Retarded" can be a perfect description of a person's gognitive function. seriously, if Rosa's parents live long enough to hear kids calling each other "Rosa," which may or may not happen, it will sting her parents far more than "mentally retarded" ever would or could have.

    5. I use "retard" as a verb but not really as a noun,although i won't say I never have. "Retarded" can be a perfect description of a person's gognitive function. seriously, if Rosa's parents live long enough to hear kids calling each other "Rosa," which may or may not happen, it will sting her parents far more than "mentally retarded" ever would or could have.

  3. Children and adolescents will be children and adolescents. I guess such was the case in the 16th century as well.