How can I get through med school if I dislike group work?
September 8, 2013 8:33 PM   Subscribe

I've just started medical school and the emphasis on group work is overwhelming me. I know that medicine is generally a team-oriented profession. I have certainly worked well in teams before, and found it enjoyable. I am affable and pulling my own weight is never an issue. Still, the fact that I have to work in a group for four hours a day, five days a week, is draining me like no other. I am angsty and tired. Please, fellow introverts and independent workers, especially those who are familiar with medical education -- how might you approach working in a heavily team-oriented environment? Details inside.

I am very introverted and fairly independent. I am also not a consistently engaged/enthusiastic person, which I feel strongly works against me in our peer and professor evaluations (they evaluate us on how we interact and work with the team) -- personally, I would rather be distant and unengaged than feel like I'm putting on a show for people.

When I am in a group, I am typically not very invested in how the group performs and unless I find that people are grossly incompetent, I won't try to lead the group or impose my ideas on the group. I have confidence in the quality of my work and ideas but like to really think things through before putting forth any of it. Am I doomed to poor evaluations and general agony for the next four years (or the rest of my career) if I dislike group work and demonstrating enthusiasm 24/7?

Other factors that are making things difficult for me:
1) I am not a memorizer, and I tend to prefer learning about ideas over facts. Thus, I am not truly enthusiastic about talking about the material that is covered in the first-year curriculum.

2) I am highly non-confrontational. I also I have a general tendency to think that people dislike me or do not think highly of me, even though I cognitively understand that this may not be the case. There is somebody on my team who consistently makes rude comments that has progressively irritated me over the past several weeks. This makes group work even less enjoyable than it normally would be, but I have not said anything and do not have the self-confidence/assertiveness/general position in the group dynamic to say or do anything about it.

3) I currently probably have some form of PTSD from previous events that is making it even more difficult for me to want to relate to/interact with people. It's not that significant because I know that my personality would be like this regardless, but I figured it was still worth mentioning.

4) Also, when I say that I'm reluctant to consistently exhibit enthusiasm, I don't mean to say that I'm not enthusiastic about my work or about medicine. I just don't outwardly show it all the time.

posted by gemutlichkeit to Human Relations (13 answers total) 15 users marked this as a favorite
I am not familiar with medical education, but I feel that this is very similar to my current situation in business school. As an introvert, it's hard to go to a program that's all teamwork all the time. Given what you said about your lack of self-confidence and PTSD(!), you should probably look at talking with a therapist to work through these issues on an ongoing basis.

That said, here are three thoughts I have that have helped me:

1. Recognize that this is school, not your career. You will collaborate with people forever, but it's rare that you'll be shackled to them for weeks at a time.

2. If possible, break the work into parallel chunks that can be done individually and meet only when you need to combine work done to date.

3. Even when I don't care about team performance, which is most of the time, I care about my performance. If that means doing the best individual work I can, great. But if it means sucking it up and doing extra or working in a way that I don't like, I'll do that too. I do it with gritted teeth, but I know that the outcome is worth it.

Good luck.
posted by tau_ceti at 9:44 PM on September 8, 2013

Please believe me from the depths of my soul when I say that this is going to only get worse, as an external factor. However, it will get more tolerable because you will adapt and become more adept at coping with the ridiculousness of the situation. Unlike myself, as every time I hear the phrase evidence-based medicine I laugh hysterically until I'm just weeping on the floor in bitter rage.

The following may very well not be your reality, but it is certainly a worst case scenario that is very valid for the majority of schools: Faking enthusiasm is very literally at least half of your grade during clinical years, and the charade really never ends. Obnoxiously fake sociopathic extroverts will get killer grades while you wait for someone to expose their lies and bullshit (that day will never come, I promise you.)

Unfortunately the only solution is that you need to work on pioneering a new, false personality not only for your backstabbing, insane fellow students but also your future coworkers (sweet holy hell, the people who work in academic hospitals) and perhaps most surprisingly for me, the discovery that you can't really be yourself with patients either.

Yes, it will drain your soul. You're probably going to need therapy to get through this, so start now rather than later. Medicine is not what you think it is. Your school will pretend to care during the basic sciences but during clinicals will throw you to the wolves. At some point you will become a wizard at figuring out what things are really mission critical out of any given list of impossible tasks you are charged with at any given moment.

For whatever reason, in the United States someone made the decision that an essential part of the curriculum of medical school is breaking down the vessel that entered to be reforged into a doctor. Like any other process of destruction, it doesn't always go well for the object of sacrifice.

Also, doctors who have graduated from residency instantly whitewash the horror of their immediate psychic history and sweep it under the rug. Your fellow students will also frequently claim it's not that bad. Ignore them, they're likely either sociopaths or on the verge of a nervous breakdown. Frequently, it's both.

Your school will also lie to you about various stuff, saying that you have access to methods of recourse with unfair grading, and that you won't have to stay in the hospital as a student for more than a single 12 hour shift. Nearly every violation and basic, common sense guideline they talk about in your medical ethics class will be something you will later personally witness; there's a reason they write those books. However, you will probably be unable to do anything about it at the time. Medicine is a very strict hierarchy.

On that note, your school at some point during basic sciences will say that medicine is a team effort, and that your contributions are valuable, if you see something that you think is a mistake you should speak up. This is a lie. Nine times out of ten, you will be punished for being anything other than a cheerleader, and the sheer technique, skill and vigor of the ass-kissing you will witness will be deserving of an extended epic poem, or at the very least a origin trilogy.

In conclusion, you need to change because the system absolutely will not. You need to become a memorizer, at the very least. While the practice of medicine frequently involves critical thinking, medical school involves none. Learn how to rote memorize and make it stick as soon as possible. The licensing exams make a big deal out of appearing to involve critical thinking, but at best it is advanced pattern recognition. Without the foundation of memorization you will founder. Everyone is capable of memorizing material, I promise you. You will have to figure out what works best for you out of all the various techniques people use, however. The personality stuff - you need to learn how to fake it, and also (preferably) the least self destructive coping method to deal with that stress. Work on an extended support system, keep in touch with your friends and family, if they're the supportive type. As a side note, medical students make absolutely terrible friends, so keep that in mind that the people you spend the most time around are also those least suited to helping you make it through this.

For the group projects, and for all your courses, figure out whatever is the absolute minimum you need to do and only do that. I never went to anything that wasn't strictly required, and if I had attempted to treat attendance in medical school like it was undergrad, I probably would have either failed out of school, or gone to live in a monastery or something. You are the one who is ultimately responsible for learning the material, above all else.

Prepare yourself for the worst, and hopefully you will be pleasantly surprised. I will readily admit there are plenty of exceptions to what I've outlined above, but I encourage you to go into this with your eyes wide open. Quite a lot of people think that hard work alone will get you through medical school, but academic medicine is a very insulated bubble of the working world, and inside that bubble there are a lot of very sheltered morons with very dangerous ideas about how the outside world should work. There are also a lot of great people out there, but they're rarely in charge.

posted by hobo gitano de queretaro at 10:38 PM on September 8, 2013 [32 favorites]

I'm a physician.

Fortunately for you, not all of medical school is group work, there is a lot of it that involves working/studying solo. Particularly for the first and second year classes (aside from problem-based learning sessions) and for the Step 1 and Step 2 licensing exams. Also, the clinical rotations are going to have shelf exams, and you'll be able to do some electives where presumably you'll choose non-team-oriented elective work, like radiology or pathology. In order to have gotten into medical school, you're probably a good test taker. So focus on studying for the exams and you can use the exams to pull up your grades if you're getting poor evals on the team participation stuff.

I'm looking at the preview here, and I think hgdq is far, far more cynical than I ever was about medical education (and I had my cynical moments). But I am a semi-extrovert who did decently on the tests but used subjective evals to pull my grades up in most cases, rather than the other way around. And I did really enjoy a lot of parts of medical school, although it was incredibly hard and trying at times.

It is certainly true that you must become a memorizer. I can't imagine making it through otherwise. And also that you need to strongly consider going into a specialty with little to no direct patient interaction if you don't want to have to act like you enjoy working with and interacting with others, even when you don't sometimes. I mentioned radiology and pathology above, other possibilities are anesthesia or possibly surgery.

The thing is, there is a reason why part of getting through med school is being able to demonstrate good interpersonal and communication skills and being a good (and even enthusiastic) team member - because that's a big part of being a successful doctor in most of the other specialties. You're going to be subject to "360 degree peer evaluations" in your future career. You're going to get bonuses/salary adjustments based on your Press Ganey scores. If you can't conjure up a good bedside manner, you're going to have to have unpleasant dealings with patient advocates or your quality assurance people all the time. If you can't treat your colleagues with respect then you'll face even more unpleasant "sensitivity trainings" or even get fired - physicians don't get fired often but I've seen it happen for not being able to play nice with others.

Many med schools offer free counseling services - now might be a good time to think about making use of yours. Best of luck and I hope things get better for you.
posted by treehorn+bunny at 10:52 PM on September 8, 2013 [9 favorites]

I'm only pre-med, but I felt compelled to weigh in.

1) Force yourself to find things that are interesting in your curriculum. I'm not a memorizer by nature either and I wouldn't be able to slog through the beast that is the MCAT if I didn't have some motivation that doing well will get me what I want out of life (admission to a good school and a ring on my finger). For example, biochemistry is literally the only subject I find interesting on the entire MCAT syllabus but I force myself to notice interesting and funny things in other subject areas like general chem and physics so I'm able to do well on those areas. Just like in high school and college, you may find that after a while of force-feeding yourself boring information, you may actually start to cherish the connections you make between different topic areas. One trick that helps me is starting my "dry" reading with a forced smile on my face until I'm settled into the subject.

2) I'm passive aggressive too and the idea of suffering through four years of PBL sounds utterly revolting; there's a reason HMS' NP is not on my top 10 list of ideal med schools. Two ideas to help you through: (a) bring food to meetings and (b) start feeding the ego of the person putting you down. The former will win over the hearts of other stressed out people and the latter will disarm and confuse your attacked such that they start to like you enough to have an incentive to cooperate with you. If you have some time over break, maybe read "How to Win Friends and Influence People."

3) I'm taking a Psych class right now that makes me think I probably have PTSD too. Don't worry about it. You can't change the past, so just focus on what is in front of you: doing well in your first year and setting up good study habits for the USMLE Step 1. If you have time, consider implementing an exercise routine into your daily schedule.

4) You've accomplished something >60% of all premeds will never accomplish: matriculation into a medical school. The fact that your school admitted you means that they know that your hard work on the MCAT, your consistently high grades, your extracurricular accomplishments, and your interview/people skills proved that you have what it takes to make it as a doctor. Give yourself some credit and stay positive. If anything, I admire you for seeking advice so early into the year because it shows that you're dedicated to self-improvement and humble enough to diagnose problems as they arise--valuable skills for a humanitarian and necessary skills for a physician. You're going to be just fine.

posted by lotusmish at 11:13 PM on September 8, 2013

I went from finishing my PhD to working in an advertising agency in a matter of months, and the hardest part for me was learning to work in a team.

I'm not sure if this helps at all (I've definitely never been to medical school), but for me, the biggest thing that helps is making an effort to make a plan and set benchmarks. Endless concepting sessions with no end in sight make me feel claustrophobic; I like to start every working session by spelling out where we need to get to and what 'done' looks like. My (creative) partner is much more extroverted than me, but understands that I need the structure or my energy dies.

I also taught at university, and some of my courses involved group work, but I think any professor worth their salt will understand that some people struggle to speak up. Have you spoken to your teachers about your concerns re: evaluation? How do they assess quieter members of the group?

But I want to second what Treehorn Bunny said - working with people and communicating well are professional skills. Yep, working with people can be difficult, and you have a lifetime of grating coworkers ahead of you, but it's important to learn how to be expressive, how to participate, and how to be sociable. This is a discussion to have with your therapist.
posted by nerdfish at 2:17 AM on September 9, 2013 [1 favorite]

I watched a loved one go through med school. He received an excellent education; his emotional life was left to his own management, and otherwise terrific professors were absent as far as students' personal well-being. Please, please take advantage of any counseling/therapy services your institution offers. Consider it skill-building and burnout prevention.

There is somebody on my team who consistently makes rude comments that has progressively irritated me over the past several weeks.

Don't be baited. Keep calm and carry on. Master the art of the level look and the non-committal "Hmmm."
posted by MonkeyToes at 4:23 AM on September 9, 2013 [1 favorite]

I'm in the last few months of my medical degree.

Shitty uni group work is a different beast to hospital team work. I despise doing group assignments and having to co-ordinate them, but however much the educational buzzwords try to spin it it's not the same as working in a medical team.

Medical school has changed me, and made me into someone who could do that job and work in those teams. Four years ago I was extremely introverted and anxious. After my first presentation to the group one girl (not unkindly) mentioned to me, "You know you get really red when you speak?" It is a skill I have learnt with time, much like cannulation and auscultation (perhaps a lie, still can't hear diastolic murmurs).

You don't have to be a polished extrovert today, but some of the skills required you will pick up if you let yourself be open to it. You can do this.

And you don't have to be effusive to show interest.
posted by chiquitita at 4:45 AM on September 9, 2013 [1 favorite]

I am a resident with fairly recent memories of med school. I also consider myself very introverted. While I agree with the spirit of hobo's comments, I wouldn't quite put it in such apocalyptic terms. I do think my clinical grades were negatively affected by my quiet personality, but it was not the end of the world and I ended up in a good residency doing things I like. I sense a lot of anxiety in your post about the need to "stand-out" in the study group. The standard advice is that you should train yourself to become more confident and assertive and I don't disagree with that. But the reality is that medical school is hard enough already without embarking on a social engineering mission to change yourself from April Ludgate to Leslie Knope. It's true that people with a natural self-confidence will get better grades in medical school but it doesn't mean that all hope if lost for the rest of us who starts off a bit timid. I am discovering for myself another type of confidence, the type that takes years of learning, the accumulation of knowledge and skills. This confidence (and assertiveness that comes with it) is earned and is available to anyone who is willing to work on it; it may run slower than the quick silver stream of the naturally confident, but it does not require you to change your nature.

So certainly try to be more vocal in your study group, but if the other gorillas are beating their chests louder than you, don't become discouraged. Your job is to learn medicine, to become a good doctor and that has very little to do with your participation grade in small groups in the first two years of med school, which, incidentally, don't count very much anyway compared to the third year clinical clerkships.

1. A lot of med students are not "memorizers." The volume of information you need to process will initially seem overwhelming, but remember everyone is in the same boat and no matter how non-chalant they look, the students next to you are probably pissing in their pants about the amount of memorization they need to do. I find that getting exposed to the same information in different formats (books, flashcards, pictures) can help. Teaching the information to others can help. A lot of times you will feel like a force-fed duck destined for foie gras, but gradually you just get used to it.

2. It's unfortunate that you have a rude person in the small group. It's hard to suggest what to do about this without knowing the nature of his rudeness. But is it possible just to exchange an eye-roll with others when he acts up and brush it aside? That's generally my approach to rudeness. Of course, if he is singling out you for insults or bullying, you should definitely call him out on it or shank him in the yard during the study break.

3. I can only sympathize that you are deailng with PTSD. I hope you are getting needed support for this. I am a little concerned about your comment of your "difficulty interacting and relating to people." Perhaps you phrased it wrong but if you actively dislike engaging with many strangers on a hourly basis, and you don't see this changing for yourself any time soon, you may want to consider the "non-clinical" specialities like pathology and radiology as tree-horn bunny suggested. But keep in mind, actual medicine bare no resemblance to these Lord of Flies study sessions; you may be surprised by what you enjoy come third year clinicals.

4. The display of fake enthusiasm is a fine art honed by generations of medical students. I was never very good at it. Again, not the end of the world. Perhaps the next time your attending show you something that he/she thinks is absolutely thrilling but you think is quite dull, pretend you are recieving yet another home-knit Christmas sweater from your aunt; manipulate your facial muscles accordingly.
posted by Pantalaimon at 5:51 AM on September 9, 2013 [3 favorites]

Best answer: I am in my last year of medical school. Your description of yourself sounds just like me and yes, sometimes I get very angry that someones used car-salesman personality got them farther then all my years of consistent hardwork got me (especially on aways - not being an extrovert hurts you there). Also, I come from a humble background of non-doctors and all the nepotism in medicine make me very angry. However, it's really not all like that and WOW is that a cynical take on medicine up there. I've noticed that medical students and sometimes physicians just LOVE to wallow in how hard it is like it's some sort of achievement to be tortured more than your peers. I just avoid those people. It's really not that bad and most of the time it's fun and rewarding. The aggressive culture is changing too - I only get yelled at or hit by the older attendings the younger ones aren't buying into that culture anymore and are much more supportive of students (I'm talking about surgery here - the other fields are generally more benign towards students anyway).
Like you, I am very independent and didn't do as well on courses like anatomy that were all group work because of it. However, don't worry about the upcoming clinical years. There's something very different about being a part of that team. It's not the same as being trapped with 3 other people in PBL groups all week. Everyone has a defined role - you, the intern, attending, etc. I am introverted but I operated very well in that environment. I'm not a charmer and I'm quiet but I didn't get a negative comment all year regarding my interpersonal skills. And people do see through other students bullshit - attendings might not but residents do and where do you think a lot of your feedback comes from? I became good friends with many of my residents and part of what worked for me (and I don't recommend this for everyone) was gently mocking the stereotypical over-eager gunner med student. For instance if they asked me to do something terrible like see an unstable patient on our prison floor or if I got splattered with blood or whatever I would smile and thank them for the wonderful opportunity and we would all laugh and I would go and do what needed to be done. I couldn't fake it so I joked about it. You HAVE to laugh about how ridiculous it is and trust that everyone knows it is ridiculous. You don't have to pretend to be enthusiastic about everything because no one is enthusiastic about colostomy bags at 4am and it's weird to pretend you are. I actually got to do a lot that other students didn't do because people trusted me because of my independent and genuine personality. Just get through these first two years, make a few very close friends, avoid the complainers and the gunners and you'll be fine. Third and fourth year be nice to everyone and do well on the shelfs = honors. Also, find a specialty with people with personalities like'll know it when you find it. Message me if you want!
posted by Valkyrie21 at 9:16 AM on September 9, 2013 [5 favorites]

I'm similarly introverted and in my last year of med school too, and it's been a struggle. I agree with some of the other comments above that unfortunately, extroversion is rewarded. I have classmates who are big-time gunners- talking over everybody all the time, asking inane questions just to be asking questions, stealing patients from other students, blatantly kissing ass. I was sure that they'd get what was coming to them in evaluations- how all the other students hated them, they weren't team players, etc- that had to come back and bite them in the ass, right?

Wrong. The AOA list came out recently, guess how many of them are on it?

I think, unfortunately, all you can really do aside from changing your entire personality is to suck it up. It's not easy, but it's possible. And you just have to get through it. Then you can apply to an introvert-friendly specialty like rads or path :-)

If I could do it over, I'd spend less time trying to impress on the wards and more time studying for shelf exams. Since it's not in my nature to be super verbal (asking a million questions, giving impressive presentations) I tried to do more scut work type of stuff- trying to help make residents lives easier, etc. I also worked really hard on my notes and I know they were good and thorough. I tried so hard to be attentive with my patients so they would like me, and they did. But in the end I don't think any that stuff really paid off much. They remember the extroverts. (Obviously these are all blanket statements and there were exceptions but in general this is my take-away feeling.) I worked myself to the point of exhaustion which made it difficult to put in adequate studying effort when I'd get home, so in addition to mediocre clinical evals my shelf scores were average or below, too. I think I could have gotten the same eval scores with a lot less work had I just focused on being pleasant and not doing anything outright egregious. Then I could have used the extra energy to study really hard and get a shelf score that made up for mediocre evals.

Don't get me wrong, medical school has countless great moments, and on the whole I'm not unhappy. I just think extroverts have a distinct advantage, so if you're not one, you have to find a way to deal with that particular fact, whether you actually try to stand out or just find ways to cope with the discomfort. But medical school is just a means to an end and it goes by so fast- you'll be okay, even if you dread the group days. (Boy, did I. But now I don't have to go to any more!) Just accept and remember the following two things: it's going to suck frequently, but also, you're going to get through it. If I can, anyone can.

(Ha . . . on preview I see Treehorn+Bunny mentioned the exact same fields, Rads and Path. Take electives in them early, you'll love them!)
posted by GastrocNemesis at 1:36 PM on September 9, 2013 [2 favorites]

It's good to see all the med students and doctors weighing in.

As an RN I had a shorter, easier, different experience, but I can maybe offer a couple things:

1) As mentioned above, I experienced much lip service to "critical thinking". There was zero allowed in my program, only the aforementioned advance pattern recognition, if that, but mostly rote memorization and learning what types of answers were required.

2) School changed me and forced me to conform to a lot of bullshit structures and methods that I still don't believe in at all. Yet, I have the ability to conform to bullshit that I didn't have before school, and I use this new skill every single day at work. It seems to me med school and especially residency use brainwashing techniques like sleep deprivation and social isolation, not just to cram as much medical info in your brain as possible, but also to manipulate what kind of human you are so that you will be a different person at the end. The pain you're feeling now is part of that process.

3) As a nurse may I request, that if you find you genuinely are not interested in the kinds of social niceties that put others at ease, you seriously consider going into research or one of the less communication-focused specialities mentioned above. Bedside manner isn't just a nice after thought. People get better better when they have clinicians who can respectfully, compassionately, and honestly engage with them than when they have doctors who think they can solve a health problem without incorporating the patient meaningfully in their own care.
posted by latkes at 1:57 PM on September 9, 2013 [3 favorites]

Best answer: how might you approach working in a heavily team-oriented environment?

A crucial element in medical teams (which may be lacking in MS1 exercises) is clear lines of responsibility and authority. If you try to put this together in your groups, your preceptors will notice. Patient care, while team oriented, is not a group kumbaya.

I would rather be distant and unengaged than feel like I'm putting on a show for people

No matter how dumb the BS is (and there will be super dumb BS), there will be times when you are the last check for patient safety. People are lazy and busy, and if the job isn't done right bad things happen. Practice staying focused and attentive. It is helpful to do this cognitively by making a list of what the goals are and needs to happen. The need for you to seem enthusiastic and try to learn from all your clinical activities is real.

Am I doomed to poor evaluations and general agony for the next four years (or the rest of my career) if I dislike group work and demonstrating enthusiasm 24/7?

Step 1, step 2, shelf exams, etc all happen in the solitude of your mind. You'll get put on the spot and pimped all alone, and those moments weight heavy to attendings.

I am not a memorizer, and I tend to prefer learning about ideas over facts. Thus, I am not truly enthusiastic about talking about the material that is covered in the first-year curriculum

That's tough luck. There is a huge amount of arbitrary data you have to know (how much insulin, doctor?) and more that is physiologic but you won't have time to re-derive. You'll have to find a style of learning those that works for you.
posted by a robot made out of meat at 6:28 PM on September 10, 2013 [1 favorite]

[Cross posting this in response to a few memails. I know that my rambling, disjointed, heartbreakingly bleak stream of consciousness of endless despair isn't a popular viewpoint, but I believe that my perspective could be useful to someone out there. Especially if you've ever wondered why over 90% of primary care doctors would quit tomorrow if it was a real option]

Hey, prepare for the worst and you might be pleasantly surprised. A lot of people go into medicine for idealistic reasons, because of the hero worship and enormous sacrifice necessary, and don't anticipate it being more of a (slightly technical) (monopolistic) (frequently borderline fraudulent) business enterprise (with absolutely zero oversight in private practice, virtually ensuring you will see absolutely horrifying things that you're prohibited from ever publicly denouncing) that does not really ever consider their health as a measure of qualitative improvement.

I know that I was severely disillusioned by the end of it all, and my medical school in particular at that point in time was definitely an edge case. Fourth year in particular is frequently one giant vacation that I privately believe exists only to allow students to forget enough about how their third year felt to allow them to repeat the cycle of abuse during their intern year.

However, there's a few studies that come up in medical education showing that at least half of medical students in their clinical years meet the criteria for severe depression. It's the combination of long hours, sleep deprivation, social isolation, little-to-no-reward, and all too often, frank emotional abuse. More than once in the last few years I've been struck by the ludicrous nature of advising someone that their salvation lies in reducing stress, working less, strengthening their social relationships, make permanent changes in their lifestyle to eat better, sleep more, and exercise regularly....all while being inescapably, contractually chained to a hospital for at least 80 hours a week; watching my reflection seemingly age ten years overnight.

There are many, many schools that have changed their clinical curriculum significantly since I graduated. But not all. There's a significant portion of people who make it through medical school who firmly state they want nothing to do with the field ever again, and it's not always who you think it should be. Yes, it's a job like any other job, but I didn't go to school for fifteen years to go home at the end of the day and feel like a very well-paid used car salesman. The incredible open-secret shenanigans in the pharm industry alone make me feel like this whole field is completely morally bankrupt.

But I guess I was the only moron, because the majority of the people I'm surrounded by have always freely admitted they were drawn to their chosen medical specialty for the paycheck above all other factors. Which is totally insane, because for all the respect, cash, and benefit of the doubt we give physicians automatically you would think they would at least pretend to give a shit about y'know, the patients. Instead they're taught how to fake the appearance of caring according to a memorized scale of empathy probably gleaned from psychology research commissioned by whoever trains pharmaceutical representatives.

Basic sciences was a lot of fun, but I'm a huge nerd. I went into medicine because science! and helping people! and for the daily life of 6/10 doctors it's not really either of those things at all, ever. Sometimes I feel like the minimal objective good work I do is outweighed by the considerable financial burden of tests ordered, medications prescribed, hospital days mandated. I know that a lot of my patients don't fill their prescriptions, but I dare anyone to show me the residency program that takes on the responsibility of tracking down their patients that are lost to follow up and find out what happened, and to document how well the issue was resolved.

Another big problem I had as a fairly concrete, rigid thinker was that; well, people frequently say all the right things and then do all the wrong ones. Or not do them. I could never put the pieces together until one day I realized, oh! it's all bullshit. Nobody actually cares about informed consent. Or whether the admission physical was blatantly copy-pasted from the previous H&P 4 years ago. Or about establishing a diagnosis, or follow up care, or ensuring the social worker got in touch with the patient so they don't die on the street. I mean, you have to objectively conclude that medical school and residency literally beats the caring out of you, given the elaborately screened, interviewed, evaluated, examined and selected elite group of caring, generous, friendly and brilliant individuals that go into it every year.

I just felt that it needed to be said because I've never heard anyone talk about the negatives publicly, and physician suicides (sorry to go there, but it's true) continues to be a problem. My medical school class, for example, lost three people before graduation and everyone talked about what a tragic loss it was without doing a god damn thing to change the 30 hour shifts or remove the horrible, horrible abusers in the hospital. There's no reason on earth to treat fully grown adults that have been walking around this earth for 30+ years the way that many attending physicians think medical students deserve to be treated, but that's what is meant when people say medicine is a conservative field and talk about the hidden curriculum. The hidden curriculum is narcissism, abuse and the profligate denial of the basic human rights of other people who came to you in supplication, and it needs to go away yesterday.

The real irony? I fucking love my job. The actual work can't be beat. It's all the shit you have to wade through in order to get there, for no reason at all, that drives me up the wall. It's totally doable though, if you're driven enough to get in, you're driven enough to graduate. I promise.

Anyways. Most people get through it okay. I will always reflect back upon those who don't. I think it would have helped me to know that it wasn't my fault, but the utter powerlessness you have as a medical student plus the sheer ability of your fellow students to completely deny reality is quite real.

My parting words on this topic will be a stupid joke. I have concluded that when many physicians spoke the Hippocratic Oath for the first time, "do no wrong," they interpreted it to mean "I can do no wrong."

The nurses always love that one, because damn.
posted by hobo gitano de queretaro at 7:21 PM on September 10, 2013 [9 favorites]

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