Lessons From My Time In Medical School

As of writing this, I’m about 2 weeks away from graduating medical school. Woah. What was once a dream as a 5-year-old kid is going to become a reality. I’m finally going to be a doctor. I’m not one to talk much about “accomplishments” or celebrate but there is no question that getting to the point of graduating medical school is a major milestone. Through medical school I have learned not only a tremendous amount of medicine but also a lot about myself and the world as well. This article combines all of these into the most important lessons I learned in medical school.

Lesson 1: Medicine is the Most Difficult Job Out There

Ok, slight caveat – it is the most difficult job that is mainstream. Obviously being something like a Navy Seal or being the President of any country is going to be more demanding and difficult, but being a physician is also no easy task. The difficulty isn’t due to physical strain or a harmful environment, at least not physically, but due to so many different factors that add on top of one another. I learned this lesson through experience, observation, and many first hand stories.

Life and Death

The number one factor is the most obvious – people’s lives are in your hands. No matter who a patient sees – a physician’s assistant, nurse, nurse practitioner – the physician is ultimately responsible for what happens to the patient. If someone dies its on the physician. Beyond literal death, a patient’s general health is also in the hands of a physician. Medications, appropriate referrals, health advice, and being a team leader are all in the day to day for a physician. The pressure to make the best decision for the patient is always there and, to make matters worse, there often isn’t a best decision – just one that probably results in the most favorable outcome. The most stressful part about caring for people is that society demands black and white – what is good and what is bad. Unfortunately, medicine is not a black and white field and requires many judgement calls based on the individual patient, circumstances, and given medical data at the time. Anyone that thinks definitively in medicine is either god him/herself or more than likely in the trough of the Dunning-Kruger curve. For some physicians that practice in settings like the emergency room, as surgeons, or in the ICUs, this pressure to make the right decision is even more urgent and carries much more serious consequences.

It’s Constant

The number two factor in my opinion is the need to be constantly in the loop. Medicine is not the field for you if you like setting boundaries because you will be getting updates constantly on patient’s you have invested so much time into. Take for example an ICU physician who constantly needs to be updated about a patient’s condition, the medications they are on, and what other specialists come to see the patient so that they can have an updated plan. Laziness may be fatal for someone. Now multiply by how many patients are in the ICU or that they carry (probably more than 10) and factor in that patients are constantly moving in and out of the ICU. While I was rotating in the ICU, there was a physician who called the residents to get an update on the patients WHILE HE WAS ON VACATION. Yes, there was another intensivist covering for him but for that physician, those were his patients, and he took ownership in staying up to date to hit the ground running when he returned. It is no wonder 51% of intensivists were burned out in 2020 which was the highest rate among all physicians according to a Medscape survey (79% of which were before the pandemic). That is a lot of information to stay updated on and to juggle in your head! While every field is not as extreme as the critical care unit, physicians generally have quite a lot to stay updated on with their patients, paperwork, and other bureaucratic tasks that are only becoming more demanding.

The Squeeze

Number three for me is the constant pressure of being squeezed. Not squeezed for time but in the field of medicine itself. Physicians are theoretically the ones who know the most about how to take care of patients as they go through extensive schooling to do just that. However, physicians are increasingly having to report to and abide by the whims of insurance companies and hospital executives who tell them what they can and can’t do for their patients. Will this patient benefit from an injection that may relieve their knee pain? The physician might think so but the insurance company says “too expensive.” Will this patient benefit from an extra day in the ICU for additional monitoring and care? A physician might think so but the hospital administrator, who probably has an MBA and not an MD/DO, says that they should go down to the regular medical floor because they need the bed for another patient who they can bill for more procedures.

On the other side, the role of a physician is being encroached by mid-level providers such as Nurse Practitioners and Physician’s Assistants whose professional organizations demand to have the same role as physicians without any of the liability. Furthermore, since hospitals don’t have to pay the mid-level providers as much, hospital administrators have seen profits over potential patient outcomes and started to replace many physicians. People are taking the jobs and roles of physicians without going to medical school. I know many Emergency Medicine residents who can’t find jobs because they are suddenly “too expensive” to hire. There are also entire surgery departments with one anesthesiologist “supervising” an army of nurse anesthetists making the future a question for many anesthesia residents.

So, between just these three factors, you can see how medicine is a tough field. They say pressure creates diamonds, but it more reliably results in burnout and sometimes suicide.

Lesson 2: It’s Not About Learning Material, It’s About Learning to Learn

One of the biggest mistakes I made early on in medical school is trying to learn the material. Now hear me out, clearly the material must be learned as this is the material that saves lives; but, if you don’t have a good learning strategy there is no way all that information is going to get into your head let alone stick around. The old saying is that information in medical school comes at you like an open fire hydrant and you have to try to drink from it with a straw. This is very accurate. It’s not that the information in medicine is rather challenging but just that there’s so much of it. Physicians don’t have to think for years to solve a single problem like in mathematics or physics. They do however have to sort through millions of little bits of information in their heads to see which one is required in the specific scenario.

After being a less than average student the majority of my first year, which is honestly a compliment as I was barely passing, I started focusing more on my learning strategy between my first and second year. The results were incredible. I went from barely passing to being the first one done with exams scoring at minimum an 85%. Pretty good right? Not only did I remember most of the information, but it came to me quickly which was a sign that I had found my learning technique. This lesson wasn’t about a specific learning strategy per say but that before you can succeed at anything you have to set yourself up with the right tools and strategies to do so. I thought I would be able to get by in medical school with my undergraduate learning habits but probably would have had to drop out if I didn’t adapt. However, not only did I learn how to learn but I also improved my confidence in the best way possible according to the book I’m reading right now Think Again by Adam Grant. Instead of becoming confident in the end result – the knowledge, the skills, the grades – I became confident in my ability to learn and in my ability to adapt to the challenge at hand.

Now, I am much less afraid to take on new challenges and approach things I have never done before. Not because I am confident I can accomplish them but because I know I can spend the time and effort developing the skills and knowledge needed to overcome them. Once I learned how to learn, I started setting myself up for success in all endeavors, not just medicine.

Lesson 3: The Culture of Medicine is… Unique

I don’t know about you, but can you think of any other field where 28-year-old individuals are treated like babies incapable of even talking to someone? I understand that we are still students and all but is it really necessary to send a resident to double check the history we took? Why is it that no matter how well we cut the suture a surgeon will undoubtedly yell at you for cutting it either too long or too short depending on what they fancy that day? That is if you even get to cut a suture, as many times students are relegated to simply standing in place and holding a retractor for the duration of a surgery. It makes for great memes, but these memes seem to be more of a coping mechanism that we can all use to find humor in the situation.

Despite being grown adults, medical students are thought of as babies meant to soak up information while tolerating their superiors. Yes, every field is hierarchical, but nothing even comes close to that of medicine. There are cases when upper-level residents will not even talk to medical students as the information must first go to a lower-level resident and make its way upwards. Like what, how does that make sense at all? In medicine you are taught to suck it up and roll with the punches until you finally make it to the promised land of attendinghood. When someone above you tells you to do something, you do it because you do not want to risk a poor evaluation. This applies even to physicians who must answer to hospital administration by the way. The strange thing is that all of this seems to be self-imposed for the most part. Attendings do it because they had to endure the same through their training and believe the hierarchy to be a “rite of passage.” They teach their residents the hierarchy who use it on their students and the cycle continues. Until you hit the big leagues of becoming an attending, you are subject to whatever comes your way lest you want to forfeit your journey and be subject to paying back hefty student loans without an income to match. All hail the hierarchy.

Lesson 4: The Most Important Things for Health are in Your Hands

Despite how advanced modern medicine is and how much we learn in medical school, you can’t do much for someone if they don’t do anything for themselves. No matter if you are the best behavior counselor in the world or give the perfect medication combination, you are useless if the patient doesn’t do anything. What happens outside of the examination room is far more important that what happens inside. In fact, on the interview trail for residency I mentioned to many interviewers, for better or worse, that physicians have to start thinking more about patient’s lives outside of the hospital as they spend only a small fraction of their total lives in contact with the institution of medicine.

This is essentially the concept of preventive medicine and I even launched a whole podcast called The Preventive Medicine Podcast talking about what individuals can do to minimize their risk of adverse health outcomes. I am not one of those functional medicine or integrative medicine quacks that say medicine sucks and you should use “natural” treatments, but I am the person who would like to maximize what you can do on your own and adding in modern medicine to fill the gaps. If you exercise sufficiently, eat well, sleep an adequate amount, have strong social connections, and an effective stress coping mechanism, you drastically reduce your risk of many medical issues (exercising sufficiently and eating well are subjective, but my podcast guests are experts who talk about that – go check it out). Sometimes, that isn’t enough and for that medicine is there to help. Those that don’t do any of the aforementioned activities and solely rely on medication and other medical interventions likely won’t have good outcomes whether longevity or quality of life.  

So, as cliché as it is, make sure you take care of yourself. Do what you need to in order to maintain your health and if you need help, make sure to get it from qualified professionals not your random social media influencer with 1 million followers. Medical students, residents, and attendings, this means you too! Take care of yourselves so you can maximally take care of your patients!

Lesson 5: Be Grateful For Every Day

It’s cheesy, I know. But it’s true! Being in medicine you realize the duality that humans are incredibly strong and resilient, but that life is fragile and can be taken away in an instant. Every day you wake up in your own bed, can get out of bed by yourself, can feed yourself, can wipe your own butt, can walk around on your own two feet, and can button your own shirt are great days. I just named the six activities of daily living which, unfortunately, many people cannot do by themselves. However, there are also instances where humans come back from freak accidents and return to their old selves. People can bounce back from multiple rib fractures and a concussion after a motor vehicle accident only to succumb to pneumonia. The world of medicine is wild and there are so many stories of both incredible resilience and unfortunate tragedy.

Not only have I learned to be grateful my own health but for those around me as well. As Gary Vaynerchuck says, he wakes up stoked that he didn’t get a call in the middle of the night with bad news regarding a family member. I feel that same energy. Seeing people lose children, parents, and grandparents is heartbreaking and I could not imagine having to go through that. I’m grateful everyday for my health, the health of those around me, and use that gratitude to fuel my day’s activities.

A Lot of Lessons

Of course, there are many more lessons I learned along the way but these are the top 5 that came to mind when sitting down to write this. The journey to becoming a physician is long and arduous but one I would go down again and again. The lessons I learned taught me so much about myself and forged my personality into who I am today. If you enjoyed this article, please consider checking out my YouTube channel, Podcast, and connect with me on social media! If you’re a medical student, feel free to reach out to me for advice as medicine is difficult to traverse alone.