Med School Confidential

A Complete Guide to the Medical School Experience: By Students, for Students

Robert Miller and Dr. Dan Bissell; foreword by Dr. Harold Friedman

St. Martin's Griffin/Thomas Dunne Books

Chapter One 

Thinking About Med School?
Think Again . . .
 
Know thyself.
—Socrates
 
Choosing a vocation, particularly one like medicine, is a daunting task. Our social programming starts early in childhood, through role modeling, media portrayals, and questions like: “What do you want to be when you grow up?” Some people have an early, seemingly innately directed passion for a particular field that they pursue headlong from day one. For the rest of us, the path is more circuitous. Whatever your own course has been thus far, if you now find yourself contemplating a life in medicine, you must take the time to consider how it is that you got here.
 
Find a quiet place where you can be undisturbed for the next twenty minutes or so. Turn off your cell phone, your MP3 player, and anything else that can disturb you. We’re about to ask you a series of very serious questions, the answers to which will reveal much about your readiness for medical school. After reading each question, write in stream of consciousness, in the space provided, everything that comes to mind. Do not organize, filter, or censor your thoughts. And don’t worry about writing in the book! This book will be your tool and your guide through medical school and residency. Break it in and make it your own.
 
Get everything down on paper. You may be surprised at what you’re about to learn.
 
Take a deep breath and try to relax.
 
Ready?
 
Go.
 
The Four Questions to Ask to Assess
 
Your Readiness for Med School
 
1. How did you end up considering medical school?
 
2. Have you considered other career paths? Why or why not? Which other careers have you considered, and why did you abandon them?
 
3. What are your three primary motivations for pursuing a career in medicine?
 
4. What do you imagine a career in medicine would be like?
 
The amazing thing you’ll discover as you get deeper and deeper into a medical career is the great variety of answers to these seemingly basic questions. What is it that attracts people from all avenues of life, and all stages of life, to a field that involves such incredible sacrifice—a commitment of seven or more years of your life and an investment of hundreds of thousands of dollars? While it is impossible to catalogue all the reasons advocating for or against a career in medicine, there are some common threads that bear discussion.
 
The Top Five Reasons Not to Go for It
 
The easiest place to start is with some of the common myths and misconceptions that often drive people toward a career in medicine. Go back and look at your responses to the questions above. If any of the following reasons appear in your responses, you may want to more thoroughly examine your decision to explore medicine.
 
My parents were physicians
 
Family traditions are great, but if you’re contemplating med school just because someone else in your family is a doctor, think again! A career in medicine requires such deep personal commitment that the mere desire to carry on family tradition will pale in comparison. If you have physicians in your family and find yourself intrigued by their lives and careers, then by all means draw on them as resources, talk candidly with them about their experiences—and then reach your own conclusions. You’re charting your own course here, though, so make choices that work for you. If you’re getting pressure to pursue medicine from doctors in the family, ask them for an honest response to the question, “Would you do it all again if you knew you were going to start your career in medicine in the world as it is today?”
 
Remember, you’re the one who will be awake all night studying. If your motivations aren’t strong enough, you’ll likely end up unhappy.
 
The money and prestige
 
In general, physicians are well compensated for the demanding work they do. The days of your M.D. degree being a ticket to glory as the neighborhood millionaire, however, are clearly over. As a by-product of the current health-care crisis, physician salaries have stagnated and even dropped, despite increasing pressures, increasing costs, and diminishing rewards. If you choose a career in medicine, you will definitely be able to lead a comfortable life, and you will definitely be able to pay back your loans. But if your motivation for pursuing a career in medicine has more to do with a fancy car, a low handicap, and a beach house than it does with patient care, you might want to go back to the drawing board.
 
I can’t think of anything else to do
 
In deciding to go to medical school, you should be pursuing a chosen dream, not evading indecision. Pursuing a medical degree is not a casual undertaking, and anything less than your 100 percent commitment plus a complete knowledge and an understanding of your purpose for being there will likely cause you to falter somewhere along the way.
 
It’s okay to be concerned about the decision, to ponder it heavily, and it’s even completely appropriate, maybe even customary, to have some misgivings after you get started. Once medical school begins, however, indecisiveness about your overall commitment to medicine is at best disempowering and at worst crippling. As Ben notes, “The best advice I can give to someone thinking about medical school is to remember that medical training is a very intense (even brutal) eight-to-ten-year process during some of the prime years of your life. If you are excited about that, then go for it.”
 
You must seriously evaluate your options and your intentions in advance, so that if you choose to proceed you can do so with confidence. Even more important, you can articulate to yourself a thoughtful and convincing defense of your decision to pursue a career in medicine when the going gets tough.
 
The adrenaline rush
 
The practice of medicine has been described as “hours and hours of sheer boredom punctuated by moments of sheer terror.” This axiom certainly applies to medical school as well. If you have bought into Hollywood’s glorification of medical practice, though, be forewarned. Clinical practice can be exciting, and, yes, on a day-to-day basis you do manage to save lives, sometimes even in dramatic ways. But most of the days of your medical career will involve caring for the three-year-old with an ear infection, a ninety-year-old from the nursing home who is weak and dizzy, and the alcoholic with poorly controlled diabetes who has just vomited on you for the third time. It’s true that you will thrive on those cases that require quick, decisive action and get the adrenaline pumping, but your more gratifying work will often be the run-of-the-mill stuff that really involves you in people’s lives and allows you to connect with them and make a difference. In general, those who are addicted to the adrenaline rush and focus solely on that miss not only the elegant subtlety of the profession but also ultimately wind up unhappy and unfulfilled.
 
I want to help people
 
This one probably stopped you in your tracks.
 
You probably thought this was the reason you should be going to medical school, right?
 
Well truthfully, this is a noble reason for pursuing medicine. You should be aware, however, that there is a yawning chasm between the sentimental image that society has of doctors providing compassionate care for all in need and the practical realities of the resource-limited, highly politicized version of medicine actually practiced today. If you have an altruistic heart and really want to make a difference, you should absolutely consider going into medicine. But be aware that defending the purity of your intent and staying true to your guiding altruism will be a constant and central challenge to you every day of your life. If you succeed, you’ll not only directly serve your own patients, you will also lead by example and help change medicine for the good of all. To succeed, though, you’ll need to overcome the progressive dominance of business and greed in our cumbersome and failing health-care system.
 
“Those who I believe make excellent physicians are those with caring, compassion, and a desire to make people’s lives healthier in the true sense of the word,” Pete says. “Unfortunately, these are also the people most frustrated with the limitations on how we practice medicine today and they are least likely to find satisfaction in the financial rewards and quality of life of a doctor today.”
 
 
So how did you do?
 
This is an admittedly harsh list. Our intent here is not to dissuade you from going into medicine, but to be provocative and ensure that you consider your decision carefully. Of course, most people pursue medicine for a host of different reasons.
 
Now, consider our list of positive motivations below.
 
The Top Five Reasons to Go for It
 
I want to help people
 
“Wait . . . what? But you just said . . .”
 
That’s right. This item is on both the lists of pros and cons. As discussed above, altruism is, in fact, a crucial part of the physician’s character and should be a fundamental guiding principle as you enter clinical practice. At the same time, you need to be acutely aware of the contrary forces of business and profit motives that are significantly influencing the profession. Go in with your eyes open. Altruism is a powerful motivation—but your restraints on practicing it will be one of your primary frustrations and sources of dissatisfaction.
 
There is no doubt you will be frustrated and angered when lawyers, businesses, and governments tell you how to care for a patient and force you to leave good science, common sense, and compassion by the wayside. Nonetheless, you will also discover that every ounce of empathy and comfort you offer to your patients will be repaid one hundredfold, and that these are limitless resources that cannot be stipulated, dictated, or overruled. It is this wealth, ultimately, that will keep you returning to the bedside day after day and night after night.
 
I want to apply my love of science
to my love of the humanities
 
Medicine is an elegant blend of the sciences and the humanities, of the technical and the creative. It encompasses every field of science and has ever-expanding horizons. Your interpersonal skills and so-called emotional intelligence will invariably be challenged by the diverse array of patients you treat, and you will come to know and be involved in the most intimate aspects of their lives. You will, at different times, find yourself a scientist on the frontier of knowledge, a teacher making the abstruse facts of disease and treatment clearer to the frightened patient, and even a spiritual guide helping a dying patient on his final journey. Medicine will constantly test every aspect of your intellect and personality, and it will never cease to teach you and make you grow. Who could ask for a better job than that?
 
I am fascinated by the human body
 
You’d better be!
 
For the rest of your working life you will be deeply embroiled in the inner workings of every aspect of this most amazing machine. Even if you are not a biologist at heart, you must have an appreciation for what our bodies achieve and the elegance with which they are constructed and operate. This respect will be a source of inspiration during the darkest hours of Anatomy or at the bedsides of your sickest patients.
 
I want to build on my existing experience in patient care
 
Perhaps the best way to clarify your intentions about medicine is to try it hands-on. If you’ve already done some volunteer work—as an EMT, for instance—or otherwise dabbled in the clinical setting, you have likely gained important insights into the joys and tribulations of working with patients. If you walk away from those experiences finding yourself eager to go back for more, chances are you’ll be inspired in medical school.
 
I can’t imagine doing anything else
 
Some have said that because a career in medicine requires such immense dedication, the only reason to pursue it is if you truly can’t imagine doing anything else. We don’t take the analysis that far. Suffice it to say that for some, a career in medicine has been a clear and lifelong dream. Those whose dream has also been well thought-out and scrutinized tend to do well. For others, however, the discovery is more gradual—that postcollege, nonmedical jobs just never quite satisfy or fulfill the way they think a life in medicine will. Whichever route you have taken to get here, just be certain that you have adequately scrutinized that route and properly confirmed your choice.
 
A Realistic Self-Evaluation for Med School
 
If you have satisfied yourself that your motivations are proper, the next question you’re probably asking yourself is, “But can I do it?”
 
“Am I good enough?”
 
“Am I smart enough?”
 
“Am I dedicated enough?”
 
These questions are all very common to prospective medical students looking up at the daunting mountain they have to climb. It’s time for some more introspection . . . as the answers to these questions must come from you.
 
Am I smart enough?
 
There’s no question you need to be a solid student and a clear thinker to be a good physician. Indeed, the premed process often seems less about preparing you factually and more about confirming you are an accomplished student who can manage volumes of complex material. This doesn’t mean, though, that if you haven’t breezed through your premed course work you won’t make it in med school. We all had strengths and weaknesses and premed classes that didn’t go as well as we’d hoped.
 
As a whole, you should be able to perform solidly in your premed classes in order to feel confident approaching medical school. Interestingly, the challenge once you’re in medical school is less about the complexity of the material and much more about managing the sheer volume of it. While there will be times when your intellectual mettle is measured, more often than not it will be your organizational skills and not your brilliance that will be put to the test.
 
Am I disciplined enough?
 
Your discipline, commitment, and ability and willingness to focus on your medical studies are arguably the most important considerations in this list. Not only is medical training intense and arduous on a day-to-day basis, it’s also interminable. Day after day, your self-discipline will be tested and stretched.
 
Can you keep up in Anatomy so that you’re not overwhelmed come test time?
 
Can you juggle Pathophysiology, Pharmacology, and Histology tests all in the same week?
 
Can you remain sharp and engaged at 3 a.m., when your team is admitting your seventh patient of the night?
 
These challenges will tax you to your absolute limits, but getting through the experience will be one of the most rewarding things you’ll ever do. Ultimately, your self-discipline will be fundamental to your career and will be a long-standing source of satisfaction that you can call upon for the rest of your life.
 
Do I have the perseverance?
 
Okay, assuming that you’re smart enough and you’re disciplined enough, your next concern will likely be whether you have the stamina to endure when the going gets tough.
 
Medical training can be a dehumanizing process. You will often feel humbled by your peers—convinced everyone in the room is smarter than you. You will frequently be taken to the depths of exhaustion and then asked to do more. After weeks of little sleep, you will be asked a difficult question by an attending physician and then humiliated in front of others for not knowing the answer. The experience can truly shake your confidence to the core. This is why you must know, with absolute clarity, why you want to become a doctor. It is this certainty that will give you the fortitude, conviction, and self-respect to persevere.
 
Am I too old?
 
The general answer to this question is no, you’re never too old to consider medical school.
 
If you’re an older or a second-career student, however, it behooves you to be realistic about where you are in life and what your expectations are. There are many doctors practicing medicine today who had a major career shift and went to medical school as late as their fifties. If you have the drive and the passion, go for it. But recognize that much about the eight-to-ten-year course of medical training is truly grueling. It means hours and hours of studying, nights up on call, and long periods away from your family and loved ones. While older students may find themselves more adept at balancing their lives and efficiently navigating the med-school waters, they will not escape the very real physical and emotional rigors of the task. In the end, as long as you are young at heart and committed to the experience, you will survive and thrive.
 
Can I afford it?
 
There are funding mechanisms in place to ensure that almost anyone who is accepted to med school can pay for it. Doing so will likely mean taking out some hefty loans, which may have a significant impact on your long-term financial planning, but it can definitely be done. In chapters 6 and 11 we will explore, in depth, the dollar value of a medical degree, why it still is a sound financial investment despite the onerous loan burden, and how to best manage your debt service while you pass through medical school and residency.
 
There are also a number of alternative approaches you can take that will make school virtually free. Consider a military appointment with promised service after graduation, or a National Health Service Corps grant with a commitment to placement in an underserved area once you’re in practice. Such avenues are there for the taking, and with a little research, ingenuity, and careful planning, they can eliminate the onerous debt burden associated with obtaining your medical degree.
 
What about my life and my family?
 
Make no mistake—the demands of med school are very real. In order to pursue your education and your training you will, quite simply, be required to forego most nonessential aspects of your life in favor of more time and focus to study. Hobbies go largely by the wayside, and time off becomes a rare and precious commodity. Personal relationships will be continually strained by your workload.
 
It’s not all gloom and doom, though.
 
Remember that hundreds of thousands of others have endured and survived this experience before you. Striving for a balanced life is a key survival tool—and one you’ll constantly need to call on as a doctor. Recognizing when you need time to get away from work is crucial, and having family, friends, and loved ones who understand the demands on you and have pledged to support you along the way will be a big help. Many people end up getting married and even having children in the midst of their medical training. The only limitations are ones you impose on yourself.
 
 
In the end, no one but you can assess your true fitness and commitment to pursue medicine. The key is making your decision an informed one.
 
“My only words of wisdom are to know yourself fully before going into the ordeal of medicine,” Pete counsels. “Those who do not know what they are seeking from the outset are unlikely to find satisfaction in today’s health-care world. Realize ahead of time whether you are someone who loves knowing the most about a small subset of information or if you want to know a little about a wide range of health issues. Recognize as well the type of life you want: if you are looking for the 2.3 kids, the big house in the suburbs, the SUV, and the Wednesdays improving your golf game, those are still attainable, but you have to sacrifice much to get there. Knowing yourself is equally important for those who pursue the inner city or rural primary, grassroots-driven care of the underserved. In deciding whether or not to go into medicine, as with any other career, the key is in knowing not what you want to do, but what kind of person you want to become.”
 
Copyright © 2006 by Robert H. Miller and Daniel M. Bissell, M.D. All rights reserved.