Friday, October 20, 2006

So this is second year?

Last year as a lowly M1, I often found myself discussing how much better the second year in med school must be with my friends. Usually these conversations (perhaps better described as hallucinatory delusions) took place during a supper break in the middle of a marathon 14 hour study day at the library. Often we would put in days like these in the week leading up to our block exams, in which we took a test on every subject that we are studying within the span of 3 days. Pretty intense, and at the time we thought that there was no way second year could be more time-intensive than that. What's more, in second year you learn about the disease processes that can occur in the body, and all the bacteria and viruses that can cause illness. We wistfully imagined, at the time, that second year would be full of interesting lectures, and purposeful studying. Oh, the follies of youth.

Recently I read medical school described as "a roller coaster at the fair that has just burst into flames as it careens off the track into a crowd of school children, while all you can do is run around in circles flailing your arms and crying for your mother." I find more and more everyday that this is an appropriate comparison, on some level. Many med students complain about the amount of time they put into their studies, or the social activities they have to forsake to get through their classes, however I find the whole experience difficult for entirely different reasons. Don't get me wrong, nobody enjoys studying all day, and the busy work that is always added to the curriculum is no walk in the park, but I really think that the most difficult aspect of medical education, for me, has been the siphoning away of my interest in biology and my increasing inability to empathize with others.

Forcefeeding yourself molecular pathway after pathway, and disease names that, interestingly enough, all seem to include identical symptomatology is enough to make anyone wish that they had stayed as far away from the biological sciences as possible. This is what medical school does to you. You are so bogged down in detail and the "alphabet and number soup" that constitutes modern biological nomenclature, that it becomes impossible to even remember why you might EVER use such detailed information in the care of patients. This is only reinforced when a community physician visits to give a more clinically oriented lecture (which occurs maybe once a month) and details exactly how much of these details you will never need to know in practice, unless you are specializing in that area. Don't get me wrong, I'm just as nerdy as any other med student as far as being interested in gaining knowledge and learning for the sake of learning, but perhaps the most frustrating aspect of the whole ordeal is that the vast majority of us are completely unable to recall these details and concepts when asked about them later. You cram your head full of material for the next exam, and then within a week you purge it all out in favor of the new details you need to learn. There is almost zero long-term retention involved, which leads one to wonder if the object of the first two years of medical school is less to learn about the basic science behind medicine and more about how to work yourself like a dog.

As I mentioned previously, my ability to empathize with others has also been shot in the foot during the past year and a half. I'm not sure whether I have already started to see the difficulties in other people's lives as a by-product of their own actions (e.g. an overweight 55 year old man whose diet consists of junk food and alcohol wondering why he has cardiovascular disease) or if I am suffering from some kind of "messiah complex" where I compare the hardships in others lives and find them wanting compared to the frustration in mine. Either way, it's not a very healthy problem for me to have at this stage of the game, and I am really dreading to see how things will change when I reach the clinics next year. I always swore that I wouldn't become that emotionally removed doctor that we have all met, but in the end it might be better than resorting to the judgment and resentment that some physicians (especially in their training years) have towards their patient and the field in which they work.

/Psychiatric Self-Evaluation