5 Things You Don’t Learn in Medical School

I smoked a cigarette.  It was my first time.

I was exhausted, stressed, and had no idea what I was going to do with the rest of my life.

I had just finished taking my first medical school exam.  I knew I was a failure and would soon be kicked out of school.

My friend Jeff was outside smoking, so I asked him if I could have one as well.

For the past few weeks I had been waking up 2 hours early, studying, then going to class.  I would get home and study until Katherine got home.  We would eat supper and then I would study until I went to sleep.

To break up the monotony, I would occasionally go to the book store….and study.

After taking this test, I had no idea what I would do next.  I was convinced I was a fraud and would soon be found out.   Could I get my tuition back?  Jeff and I bounced ideas off of each other.  Jobs we might be able to get.   Would I move back home? Or stay in Kansas City?

But all this worry and anxiety was for nothing.  When I got my grade back, and found out that I hadn’t failed.  In fact, I had done well.  I realized something.  I could study a heck of a lot less.

This was a life lesson.  Worry less.

Sometimes you have to learn things the hard way.  Sometimes you have to make your own way.   Sometimes you just have to learn as you go.

Do the hard work, then trust the process.

It will be what it will be.  Work hard and the rest will work itself out.

Now, I’ve also learned some other things in my profession.  Things that they don’t teach you in medical school.

5 Things You Don’t Learn in Medical School

Letter Writing 

I write a lot of letters for people.  Letters to lawyers, judges, police officers, landlords, city officials, employers, schools.

Besides the usual (Please excuse so and so from school/work), there have been some interesting topics.

Here are a few of my favorites:

To whom it may concern:

Please excuse my patient from jury duty.  She has a bad back.

To whom it may concern:

Please allow my patient to have a cat and/or dog in their apartment.  It is important for their mental well-being.   It will be good for them.  Trust me.

To local law enforcement:

Please do not arrest my patient anymore.  She’s crazy and shouldn’t be held accountable for her actions.

To local law enforcement:

Please release my patient from jail.  She’s crazy and need’s psychiatric care.

Now, before you start accusing me of being insensitive, those last two were worded just as I was asked to write them.  But, I adjusted the wording and made the request a little more appropriate in the actual letter.  This is where the letter writing skills come in handy.  It’s more an art than a science.  You have to be able to balance what the patient wants you to say with what actually needs to be said. And, sometimes, you just have to say no.  Some letters shouldn’t be written.

Letter writing is a lost art.  I have had to adapt my skills.  My office manager helps.

I could have used a few lessons in school.

The Internet Knows Best

You are nothing but a second opinion to WebMD, Wikipedia, and Dr Oz.

What was once a resource to find out more information has become a tool for self-diagnosis.  This isn’t all bad of course.  But it brings a whole set of complications.

And before you get sucked in, let me go ahead and warn you.  No, that supplement derived from the droppings of a rare porcupine found in Australia will not help you lose weight.  Except, the weight lost from your wallet.

Like most cases, honest communication with your patients will trump other information.  But you are fighting an uphill battle with the internet.  It has a force similar to the dark side.

And maybe I would go so far as to say, “Don’t trust anything you see on the internet”, but I can’t say that.  Because I want you to keep reading.

So, if you are going to get information on the internet, you might as well get it from me.

But like Abraham Lincoln once said, “70% of what you see on the internet is made up and 2/3 of all statistics are a lie”.

Listening

Listening is important.  That’s obvious.

And medical school does teach interviewing skills.  We practiced a lot.

I used to have trouble getting a good history and then writing it down and having to “present” the case to  my attending.  Presenting to an attending means basically you are telling them what happened.  It has a certain structure and order.  It’s a narrative of events that should help lead you to a diagnosis.

My scattered, attention-deficit brain doesn’t like to put things in neat, orderly fashion.  I was very bad at this at first.

I got better on my psychiatry rotation.   Yes, that’s right, the Psych Ward is where I learned how to effectively take a history and physical and put it into a proper narrative form.

When you practice getting a coherent history from a patient that thinks they are the re-incarnated child of Jesus and Marilyn Monroe, you have no choice but to learn.  You learn to see the big picture.  You learn to see the timeline.

But listening is not the same as getting a history.

We get too caught up with checking off the boxes in someone’s history that we forget to listen to the story.

Every patient has a story and it is just as important as when they last ate, whether they passed gas yet, if their swelling has gone down, or if their pain is 4/10.

To listen to the story and not just the history, that is the art of medicine.

You are taught to take a history, but the magic happens when you learn to listen.

The lesson is this:  Sometimes a patient just needs you to listen.  They aren’t always looking to be “fixed”.

Medication is poison

You are taught a lot about medications in medical school.  But it’s not until you are out  in the real world that you learn anything.

In medical school, you are taught medications have risks.  You are taught to look for interactions.  You know there is always danger.   But these things are easy to forget.

And it is all too easy to pick up a prescription pad and think that this holds the answer to any problem your patient has.

The body wants to heal itself, and often the best we can do is to optimize this process.

Medications should be used sparingly.

Some patients have medication lists longer than your arm.  The practical compliance limitations and financial burden is something we often overlook.

Medication is deadly and expensive and should be used with extreme caution.  Yes, this is taught.  But you don’t learn it.  Not until you are the one holding the prescription pad.  Not until you sign your name on the line.

Sir Willam Osler, known as the father of modern medicine, put it this way: “The person who takes medicine must recover twice, once from the disease and once from the medicine”.

Everyone Dies

Spoiler alert.  Everyone dies in the end.

Not to be too negative; this is just a fact.  And of course we all know it, so there is no reason to teach it.  Right?

If you feel your job is to keep people alive, then you will be sadly disappointed.

According to Hippocrates, we should “Cure sometimes, treat often, and comfort always”.

It would be good to remember that our job is not to keep people alive, but to give comfort to those that are sick.

As a physician, I can give advice.  I can prescribe exercises or medications.  I can provide manual manipulation.   I can make recommendations that statistically speaking should prolong your life.  But the most important thing a physician can do is to reduce suffering and ease the burden of the wearied soul.

You can’t really learn this in medical school.  You learn this when you it’s just you and a patient.  It’s a lesson learned with time.

So this is just a brief list of the things I didn’t learn in medical school but have been important in my career.  It’s not all inclusive.

In a way, they were things that were taught but that took me a while to learn.

But I continue to learn.  Everyday something new.

And this may be one of the best things about being a physician.  I learn more from my patients than I can ever teach them.

P.S.

To my friends in school.  Keep your head up.  Worry less.  Trust the process.  Listen to your patients.   And for the love of all that is good, Don’t Smoke.

P.P.S

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