Guiding Principles for Medical School.

Dear Jane:

Thank you for ask­ing me about my per­spec­tives on med­ical school. Here are some gen­eral prin­ci­ples that you might find use­ful in your own training:

View every­one as your teacher.

Every­one you encounter will teach you some­thing. Be open to what they have to offer.

Yes, your pro­fes­sors and attend­ings, the “offi­cial” teach­ers, will edu­cate you. Patients, how­ever, will often be your best teach­ers. Lis­ten to what they say, watch how they react to what you do, and acknowl­edge and accept the feed­back they give to you. Their teach­ings are often the most use­ful and valuable.

You might see a physi­cian con­de­scend­ing to a patient and decide that you never want to do that. You might see a nurse offer quiet com­fort to a patient and decide that you want to mimic that man­ner. You might wit­ness a tech­ni­cian help a patient feel less anx­ious before a pro­ce­dure and decide that you will steal that tech­nique. You might talk to a physi­cian on the phone and decide that you will adopt that pro­fes­sional and kind man­ner when you talk to other physicians.

In this way you can be a stu­dent for life.

Reflect on your expe­ri­ences every day.

This can take many forms: You can keep a jour­nal. You can talk with friends. You can med­i­tate. You can go for a ten-minute walk around your neigh­bor­hood. You can sit in a chair and stare out the win­dow. It doesn’t have to be a big thing.

Reflect­ing on your expe­ri­ences will help con­sol­i­date what you learn so you can apply that knowl­edge in the future. This applies to “book” knowl­edge (phys­i­ol­ogy, phar­ma­col­ogy, etc.) and “non-book knowl­edge” (how to redi­rect a patient or your col­league, how to man­age your emo­tions in the face of dis­ease and death, etc.).

There will be times when you will feel over­whelmed and can­not or choose not to reflect. That’s okay. It happens.

You will see ter­ri­ble things.

You will see peo­ple suf­fer. You will see peo­ple die. You will hear hos­pi­tal staff say deroga­tory things about patients. You will see your col­leagues lie about things they should not lie about. You will see everyone—the patient, nurses, doc­tors, tech­ni­cians, fam­ily members—work as hard as they can and none of it will help the patient. You will see peo­ple who need help, but don’t want it.

Remem­ber the dis­com­fort you feel when you see things you don’t like. These expe­ri­ences are your teach­ers, too. They will help you stay human and humane. Med­ical train­ing can steal that from us.

You will do ter­ri­ble things.

You your­self will do things you will not like. (Hope­fully infre­quently.) You will snap at patients. You will be snarky to staff. You will bend the truth, if not lie, because you won’t know what else to do.

You must reflect on these events so they don’t become habits.

Con­nect with physi­cians who do not work in aca­d­e­mic cen­ters.

Some physi­cians in the com­mu­nity will have prac­tice pat­terns and work in sys­tems that will appall you. Some will inspire you. While aca­d­e­mic med­i­cine does hap­pen in the “real world”, it’s often dif­fer­ent from what is in the community.

Expos­ing your­self to the non-academic world will help you learn about a greater vari­ety of patients, cre­ative and inno­v­a­tive devel­op­ments in health care, and pro­vide more con­text about med­ical care in the world. Even if you end up work­ing in an aca­d­e­mic cen­ter, these expe­ri­ences will shape your practice.

After you decide what kind of doc­tor you want to be, take rota­tions in every other specialty.

Med­i­cine is com­part­men­tal­ized, but peo­ple are not. Your patient with high blood pres­sure may become preg­nant… develop a pain­less red eye… frac­ture a bone… have her gall blad­der taken out… or develop an alco­hol prob­lem. Learn­ing about a vari­ety of con­di­tions will help you take care of peo­ple, not just diseases.

The most use­ful guid­ing prin­ci­ple for me dur­ing my train­ing (and now) is to remem­ber that your work is to take care of the patient. It’s not about the let­ters after your name, long titles, or how big your salary is. Med­i­cine isn’t about you. It’s about the patient. That atti­tude will keep you hum­ble, curi­ous, and grateful.

Con­grat­u­la­tions on your admis­sion to med­ical school! May you find the work reward­ing and meaningful.