Medical school and residency aren’t places for human growth

The end of my residency and beginning of my practice was the most wrenching experience of my life.  I was woefully prepared for the transition.  Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes.  Things have changed considerably, but the psychological passage I endured still holds.

I think my process of becoming a surgeon was fairly typical, with the exception that there was no one in my family in the medical field.  All the doctors in my family, including all my siblings, are PhD types.  So through basic education, I was generally the smartest in my class, with all the baggage that entails; especially an growing up in the streets of New York.  Socially ostracized, socially inept.  Family outings were things like a Sunday drive to West Point to watch the Military Band concerts.

Then off to an Ivy League School to enter the contest for medical school admission (only 10% got in in my era.)  Not really difficult, but did involve a lot of studying.  I had 8am Saturday classes every semester.  No Friday night parties for sure.  Acceptance to med school upped the ante.  Now it was time for serious studying and ridiculous memorization; most of which has since become outdated.  All to get good grades and a good match for residency.

Then off to another hospital for residency, where you are treated alternately like a slave, and a social reject.  It has now been essentially your entire adult life with no training in any of the social sciences and the art of human interaction, and minimal normal social interaction.  The hierarchy of hospitals could only be called normal in the military.

Then you finish your residency and move to a new practice, and when you walk into your new hospital, you are afforded God-like status.  Where in this process is there any time or training to become a social, reasonable individual?  You train for years to be as perfect as possible, and then are damned for being a perfectionist.

In addition, I had a problem that compounded my difficulty.  I have no memory of ever wanting to be anything but a surgeon.  When at age 9 I broke my arm, I told the surgeon who treated me that I was going to be a surgeon when I grew up.  He responded condescendingly.  So now, I was a surgeon … what to do with the rest of my life?  What goals to strive for?  A very heart-wrenching experience indeed.  It took me over 5 years to get my head even partially screwed on straight.

Medical schools should offer courses in negotiations.  I took one at a law school, and found it very helpful.  Also human growth courses are also helpful.  My favorite place to go is Esalen, though I haven’t been there in years.  Any intensive course, taught by a competent psychologist will be helpful.  Learn how to interact with people and separate your professional perfectionism from your social realm.  Become a part of your community.

Paul E. Smith is a surgeon.

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  • Sophie Zhou

    Schools are much more tuned into the social development of doctors nowadays. With standardized patients and such, students are taught how to interact. Also, more and more non-traditional students are becoming physicians (less bio majors). The eclectic mix of people from different backgrounds provides a great environment for people to grow socially as well as academically. But I completely agree with the course offering idea. Schools should definitely push for a more balanced education. What is your opinion on bringing in some liberal arts?

    - alittlehappi.blogspot.com

  • dave comstock

    Perhaps the answer is to start changing the culture of schools and teaching hospitals to admit older applicants, who have already had some experience in being human beings?

  • http://pulse.yahoo.com/_347QEL3HBMINQRAFAQEM56UGJY hgd

    What pointless drivel.  Thanks for that entirely meaningless essay (can it even be called that?) which seems to exist to assert 1. how smart your family is in a pseudo-subtle way 2. how smart you are (oh just “off to an ivy league” school eh? Was it necessary to let us know?  What was the point? Are other schools not as rigorous? Or is it indicative of how hard you must have worked all through high school. Oh my, those volunteer hours.  Those months studying for the SAT.  Wow.  World changing.) and 3. to bring up how valuable you must be as a doctor. 

    I”m blown away by your writing skills.  You’re right.  Med school and residency offers no time to develop as a human being.  Apparently as a doctor as well.  I can see that.  (1st yr completed med student btw)

  • James deMaine

    I also trained in the early 60′s at an Ivy medical school.  I came in with a liberal arts background from a mid-western university and initially felt outclassed by the “boys” from prep schools, etc.  Early on I identified with the Internal Medicine docs, and in fact wrote a blog piece on why I didn’t become a surgeon:  http://www.endoflifeblog.com/2011/08/why-i-didnt-become-surgeon.html

    But even though medical schools and training programs may be improving in teaching interpersonal skills, I think we still come out too immature for some of the complex problems we encounter.  We know a lot about disease, but not much about people and the skills of caring plus handling anger, death, and tragedy. I think more liberal arts, philosophy, classical literature, and sociology would help.  Also, we need to understand poverty, abuse, racial bias, and the social issues that affect our care.  The compleat physician can combine science and humanness.  I think most of us, myself included, fall short of the ideal.

  • Elizabeth Belle

    hgd – I think the author’s intent was to point out how socially inept he was/is. Academics aren’t often associated with social skills.
    I’ve had a few different jobs (food service in college, corporate, and later state-funded health), and people who work in these environments often have something in common regardless of education or rank in the organization. Their social skills are frequently atrocious. People who have to procure clients can muster up a few basic things in order to bring in money, but they revert back to flightiness, drama, aggression, etc. as soon as they’re on the way back to their office. 

    I think doctors tend to get scrutinized most for lack of social skills, but I can’t say that out of the (granted small) number of doctors I’ve come across in my travels, they as a group struck me more socially inept than the rest of society. Getting health care is an emotional experience for most people, and emotions don’t lead to great communication skills usually. I think people will perceive anything short of mind-reading in a doctor’s office as insensitive, and it’s likely they weren’t sure how to articulate what was wrong with them in the first place. I will admit doctors can get outright wacky in mannerisms, but what comes out of their mouthes makes sense and they usually aren’t jerks about things – making sense and being nice is 3/4 of the battle.

    That said, some industries stress communication skills more than others. Doing the corporate thing, I was subjected to surveys and speakers and the Myer-Briggs Personality Inventory all in the name of “so we can work well together.” Didn’t see anything remotely close to this while working for an agency contracted with The Man. Two suggestions I have are to 1) make communication skills required yearly as part of continuing education – goofy role plays required, and 2) give patients a sheet to fill out while they’re waiting for you that prompts them to explain why they are in to see you for initial appointments or “I have an owie” visits. I have told many people to write up their issues prior to seeing their psychiatrists (Communicating while ramping up on Seroquel isn’t always an easy task), and it has saved a great deal of frustration for all involved. 

  • StephenModesto

    ..Thank you for personally sharing the difficult insights of and from the humaness of your experiences. I am not a MD, I am `just’ a RN. The issues you identify in the process of validating the technology of health care delivery over the intrinsic ambiguity of the phenomenology of living life does lie at the heart of healing the wounds of both the body and spirit of the human experience. There is indeed as saddening irony when the eventual `god-like’, post-residential staus is finally benedicted, the cumulative interia of that cognitive dissonance adds even a greater distance in the understanding of the human experience of the spiritual suffering of any patient beyond whatever the the physical malady presents.
       I did have a quiet smile when you make it a point to mention Esalen. You are certainly in a social position where you have the discretionary income to afford visiting Esalen more often. Enjoy the Redwoods.

  • Gurraj Jabbal

    how well said. I to am training as a doctor in kenya and the psychological stress and impact is overwhelming. At times you feel alien like you are living in another planet and timezone.  And true majority of your life just passes by you.