Before I started medical school I thought it would be phenomenal to become a doctor. What could be more amazing than to possess a thorough, complete and intimate understanding of the human mechanism? I came to medical school to learn physiology and pathology in their entirety. I could not imagine a more valuable understanding than to fully know the secrets of the human body, what befalls it and how to counter the wreck of time and tragedy.
Two years into my education, imagine my disappointment. I soon realized what an impossible task I’d set up for myself. More often than I liked, my studies revealed such phrases as, “our understanding of the process is incomplete …”, or, “for reasons not well understood …” At the same time my mind reeled as it became clear to me that medical science has become so vast (and so deeply molecular) as to be beyond the grasp of any single person. In other words, we don’t know, and yet we know more than one can comprehend. As the inimitable Robbins text might put it, “this paradox has yet to be resolved.”
The truth of the matter is that medicine is not something to be learned. It is a landscape to be traversed. Admission to medical school was my passport. Surviving the preclinical years has been the borderlands. Next week my crude knowledge will likely be enough to pass the first step of the boards and shortly after I’ll find myself in the interior, taking histories in the clinic. Perhaps I’ll even be coming to your clinic.
In keeping with this metaphor, when I arrive with my fellow students we’re going to need a guide. If you have students who rotate with you try to think back to the days when you first arrived on your first rotation. Recall when it was that you realized how insufficient was the material of your preclinical years. Take a moment to remember that while those early studies laid a certain foundation they also served to point out how little you actually knew and that you had an extraordinary amount of work ahead.
Take a moment to remember that those of us in the short white coats have never done this before. We come to your hospitals and offices having placed our trust in this system of medical education, faithful that your guidance will buoy us successfully toward our future. Please partner with us as we prepare to become competent, even masterful clinicians.
We will seem like children, embarrassed and afraid to ask because we’ve been admonished not to ask what we can look up. Well, is there any answer one can’t look up in a book? Forgive the questions that seem to have obvious answers and know that our intentions are well meaning and good, sometimes even noble.
Help us to buck the deeply troubling trend that as medical training progresses, empathy declines. Help us to remain motivated by compassion and curiosity rather than by a fear of failure. Remember that we, like you, have committed ourselves to this profession and that one day soon, in the not too distant future we will be your colleagues.
Thomas Doran is a medical student.