Friday, September 16, 2005

Stuck in a "House" Episode

Medpundit, on med school blues:
Students leave their homes, their families, their friends. They lose the academic standing they had in college and high school, and with it sometimes, self-esteem and respect. They see and learn things they've never seen or heard of before. They learn, in fact, a whole new way of being. It is a completely transformative process in a way that few other processes (except perhaps joining the military) are.

It is not a pleasant process. I remember one of my medical school classmates describing it as "the shrinking of her soul." The reasons for this are all those mentioned in the above article, with the exception of one glaring omission - the role of the teaching process. The third year of medical school, when students enter the hospitals and see patients, also marks the moment that their teaching is handed over entirely to practicing physicians - and they are brutal. The brightest and best students are treated as know-nothing scum and burdens to be born by the rest of the medical team. There is never, never, any praise - only denigration. At least, that's the way I remember it, with few exceptions. It's like being stuck in a House episode.

So, how do we get through it? Our hides grow a little thicker (or is it that our souls shrink?); and if we're lucky we meet some good roll models along the way...


Blogger Greg P said...

My sense of what happens to us in those "formative years" is that we lose the intellectual arrogance that we later see as we practice medicine treating highly intelligent people(eg, someone with a PhD) who have done intensive research into their problem and think they understand their diagnosis and what to do about it, yet are way off base.
It becomes part of our skepticism when we hear about computer programs that can "make diagnoses."
We've already been there, and the computer program in our brain wasn't so good.
As upsetting as rounds can be to us as greenhorns, we end up internalizing that criticism so we don't jump to conclusions.

7:56 AM  
Blogger Maurice Bernstein, M.D. said...

It is because I anticipate the emotional and intellectual abuse of the 3rd year and beyond, that I discuss with my first and second year medical students this issue. I want them to know that it might happen that they will experience such abuse or witness ethical misbehavior by their superiors. Then we discuss what options the student has available to respond to the situation. Hopefully, this preparation will be useful to minimize their emotional upset and provide them with approaches which will be therapeutic to them and their affected patients. ..Maurice.

7:10 PM  

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