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Med Students/residents..what Surprised/dissapointed You The Most?


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So I think it is common for all of us to on some level romanticize careers we are interested in. I'm curious for those of you in med school, those in residency, or even current physicians, what surprised or dissapointed you the most once you actually started studying medicine?

 

In particular, I'd be curious to hear how many of you changed your interest level in a specific speciality once you actually gained experience in it?

 

 

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Want to cut through the romanticism? Sure, here is some reality.

 

Preclerkship is basically a time when you only memorize a bunch of lists. You can be an idiot, dumb as a brick, with zero creativity, but if you can memorize and spit out lists you will be a champ. 

 

Clerkship is about being somewhat slick when it comes to interpersonal skills and memorizing and regurgitating more lists. Better you are at this the better CaRMS will go for you.

 

Residency is about memorizing more lists, interpersonal skills (not being a douche) and actually applying some of the things you learn on the lists. However, when it comes to evaluation, regurgitating lists still dominates. Heck, you probably could finish residency and be a crappy doctor just fine if you could only regurgitate the lists. You see a theme here?

 

Number two surprise. A lot of what you learn in medical school is bullshit with limited or zero evidence or it is useless with no practical application. You are taught that it is gospel, you regurgitate it until you curse it. Then in senior med school or residency you figure out the truth. 

 

 

This sums up the things that surprised me the most. 

 

Oh, and yeah, I wanted a surgical specialty for a long time. Then I did rotations in the specialty and realized I don't enjoy self flagellating myself so I did somthing else. Probably the smartest decision I made over those four years.

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 A lot of what you learn in medical school is bullshit with limited or zero evidence or it is useless with no practical application. You are taught that it is gospel, you regurgitate it until you curse it. Then in senior med school or residency you figure out the truth. 

 

Too much honesty! Too much! :P

 

Thanks though, I will try to take a healthy skepticism with me. Any topics/areas specifically that you are thinking of, or is it more or an issue of scale where one starts MS1/2 with basic gospel that is "too basic" to encapsulate the complexity of the systems studied?

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Doctors are people.  You hear and see a lot.  I see a lot of unexpected compassion and kindness and a lot of unexpected ignorance and stigma.  You have to seek out ways to hang on to the good and take on the bad as a learning experience.  Otherwise you'll lose it.

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I think the other thing is that there is a tendency to polarize doctors/medicine as either Good or Bad with no in between.

 

In reality I think there is a lot of in between.

Yup, medicine is not some special place full of super heroes. Like any another random cross section of the population some people suck, some people are rock stars, most show up and are adequate. Along the same lines, some people have various personality issues/disorders, some are amazing people with magnetic personalities and are entirely selfless. Most are just normal folks at work making a living and trying to do some good.
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As an aside... For those of you who are already in medical school. Take a little look over at www.thennt.com. Look up some of the reviews on the evidence for many things which we are taught and do.

 

Moral of the story. Nothing in medicine is black and white. Medical training will simplify many things into a dichotomous point of view. This is only useful for passing your exams. The earlier you start questioning what you are told and evaluating the evidence the better off you will be in the real non-academic world.

 

Resist the typical MedEd system which wants you to chirp the ancient lines... Except on exams. Know the evidence, and you will impress, guaranteed. You might even find yourself educating others. :)

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As an aside... For those of you who are already in medical school. Take a little look over at www.thennt.com. Look up some of the reviews on the evidence for many things which we are taught and do.

 

Moral of the story. Nothing in medicine is black and white. Medical training will simplify many things into a dichotomous point of view. This is only useful for passing your exams. The earlier you start questioning what you are told and evaluating the evidence the better off you will be in the real non-academic world.

 

Resist the typical MedEd system which wants you to chirp the ancient lines... Except on exams. Know the evidence, and you will impress, guaranteed. You might even find yourself educating others. :)

 

Its funny cause many staff and residents would agree with you, but unfortunately they still have to teach it because "thats what you get examined on". There needs to be serious change at the college level to stop teaching antiquated and arachic things at times, and start teaching newly emerging technologies/techniques. Unfortunately change in medicine is something that is never met with much enthusiasm

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Yup, medicine is not some special place full of super heroes. Like any another random cross section of the population some people suck, some people are rock stars, most show up and are adequate. Along the same lines, some people have various personality issues/disorders, some are amazing people with magnetic personalities and are entirely selfless. Most are just normal folks at work making a living and trying to do some good.

I'd say there are more personality problems in medicine vs. the regular work environment. The stuff I see routinely in medicine would have gotten people reprimanded or canned pretty quickly in a regular office environment.

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I'd say there are more personality problems in medicine vs. the regular work environment. The stuff I see routinely in medicine would have gotten people reprimanded or canned pretty quickly in a regular office environment.

I think this is a problem in many health care professions. Some of the choices/behaviour I've seen, and heard, would get you fired in any other field. But, for some reason is completely ignored in a hospital setting.

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Just curious. what things would be ignored/are different in a hospital setting?

 

Kind of a bit off-topic ...I was reading a SDN forum randomly. Some of the stuff was pretty shocking to read about residency!

http://forums.studentdoctor.net/threads/terminating-residents.562930/

 

:o

My favourite examples are just outright not doing your job (i.e. not responding to pages, ignoring patients that code, etc). Essentially just standing around waiting for someone else to do their job for them.

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Just curious. what things would be ignored/are different in a hospital setting?

 

Kind of a bit off-topic ...I was reading a SDN forum randomly. Some of the stuff was pretty shocking to read about residency!

http://forums.studentdoctor.net/threads/terminating-residents.562930/

 

:o

As a resident I find that thread absolutely terrifying.  It is true that as a resident if we were to be fired, we would be totally screwed, like no program would want you.  Thankfully this has rarely happened in Canada (ive never heard of it)

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  • 2 weeks later...

Oh, and yeah, I wanted a surgical specialty for a long time. Then I did rotations in the specialty and realized I don't enjoy self flagellating myself so I did somthing else. Probably the smartest decision I made over those four years.

 

This is exactly what I went through as well.

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As rogerroger said there are a LOT of dogmas in medicine that you can't even question (withdrawing of a chest tube when the draining is less than 200 cc/24h, thoracotomy if 1500 cc of blood, and so on…)

 

In addition the emphasis of Evidence Based Medicine is sometimes SO important that you can't prescribe a drug / do a procedure if it has not been correlated to improved outcomes by a p < 0.05.

 

The contrary is also true and you see sometimes a "revolution" in medicine with the super-duper-new drug costing 12314 times more than the old one with a not so clinically significant improvement on patients...

 

What disappointed me the most? Cost of medicine related to 

1- cost of medicine related to MDs habits and inertia toward requestionning what they learnt

2- administration-related bs

3- crazy-lazy patients

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Patients often tend to not do/take what you prescribe, especially if it is not a medication (and even that…).

 

Studies show that compliance to medication is about 50-75%, compliance to physiotherapy or habits changing is even lower. You round patients on the wards, you tell them to move/perform inspirometry to prevent post-op complications and only half of them will do what you say. It is somewhat frustrating, especially when they finally catch their pneumonia or DVT..

 

I also hate the fact that every hospitals are understaffed on non-MD professionals (PT, OT, SW and so on) because of a pretended lack of funding, and yet you often see the last-crazy-high-tech-state-of-art-minimally-invasive thoracic aorta aneurysm repair performed on a 79 yo pt with signs of dementia, or a 82 yo COPD pt intubated after a fifth COPD exacerbation in the past 2 years with this time heart and kidney failure who have been assisted by a machine for way too long, with the treating MD and family unable to let him go.

 

Oh and don't get me started on the money spent on new approved chemotherapy/biologic agents costing 250k$/yr for a statistically significant 2 weeks PFS improvement

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