Here’s what the third year of medical school taught me


The dawn of 2018 brought new hopes and new promises for me as I began the third year of my medical school journey. This marked the beginning of a challenging era, one that would test my capabilities to the fullest but also one that was the culmination of countless sacrifices and the fulfillment of years of yearning. After all, this was what I had come to medical school for.

Third year is when you get to play the doctor and when you can finally hope to make sense of all the jargon that you stuffed in your brain for two years. The thought of real-time patient interaction can either get you very excited or very scared. In my case, it was the latter one. The practical aspect had always frightened me. That eerie feeling of knowing stuff but not being able to apply it in a real-world scenario was just as terrifying as being kicked out of medical school.

It’s not that I wasn’t excited. I was just more frightened than I was excited. I didn’t know enough. After spending two whole years poring over books one might think why that would be the deal. But the fact is that medical students tend to forget a lot and also because, as we soon find out, the practical aspect is a lot different from what we read in textbooks.

There is a lot to say about how third year tested me and all my fellow students to our utmost capacity and how we crumbled under the pressure. But all that stress is inherent in the medical field and complaining about it just serves no purpose. The thing I’d rather talk about is how third year changed me, how it reinforced some of my old beliefs and how it completely altered others.

I walked into the surgery rotation with the assumption that, when I would come out of it, I would know for sure whether surgery is for me or whether I had the manual dexterity needed for the surgical specialty. Here is the ugly truth: I came out of surgery rotation just as clueless as I was before. The only thing that changed, however, was that I knew it’s nothing like what Grey’s Anatomy had me fantasize. Obviously, harboring such expectations while being posted in a public sector hospital of a developing country is quite naive, to say the least. Those lofty expectations were the reason I felt really bad when at the end of the rotation I neither felt more knowledgeable nor more focused.

I went into gynecology and obstetrics rotation thinking I would never like it, but it was one of my best rotations. Not only did I learn a lot academically but I also developed compassion for all the women out there. The physical and emotional pain that a woman goes through while nurturing a baby inside her is something that words fail to describe. Suffice it to say that I started my rotation with a lot of aversion for this specialty — and I ended up developing a lot of respect and awe for it. And even though I may never consider going into this specialty myself, I don’t hate it anymore. You see, how third year changes us for the better?

I learned some hard truths as well. I realized that no matter how much we learn, it won’t be enough because our patients are not exam style questions. Each of them comes with a different story and more often than not, their stories are nothing like the classic presentations. Reading about all the symptoms gives you a fleeting sense of assurance that when you go out there, your patient is going to tell you exactly that while in reality, your patient will tell you everything but that. And it’s our job to extract all that hidden information with a set of specific and non-specific questions in mind, all while maintaining our rapport and without irritating our patients.

I eventually learned that symptoms and signs are not just a matter of words. Deciphering the incoherent tales of our patients and translating them into medical language is the real deal. What you read from a book can only partly help you take a history, you might have all the questions in mind. But when your patient starts talking, information seems to be coming from all over the place. Instead of focusing on what the patient is saying, all you are thinking is how on earth are you going to organize this piece of clutter into a decent case presentation? You see, reading about a sign or symptom is one thing but being able to appreciate it in reality is a whole different story.

So I had a tough time learning to elicit a proper and focused history from the patients. I did get better, but I was never perfect. There was always something deficient, something that warranted more practice. The constant sense of inadequacy and the non-existent encouragement on the part of the mentors really threw me off the track. It made me doubt my potential; it made me exhausted to the core. But in the end, all of it led to the discovery of a bitter but beautiful reality that medicine is not about perfection, it’s not about precision or getting things right. Medicine is about humans and humans are more than just bodies.

The secret to fathoming the complexity of human beings lies not in learning algorithms or reading textbooks but in stepping out there and engaging in as much patient interactions as we can. Even then, we might never attain perfection but what matters at the end of the day is to know more than we did yesterday. This is what keeps all doctors going; this is what keeps them thriving despite all odds and this is what will keep me striving as I begin the second half of my third year.

Manahil Akmal is a medical student in Pakistan who blogs at The Subtle Art of Existence. This article originally appeared in JPMS Medical Blogs.

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