Clinical Medicine Begins

Clinical medicine. I have started year three of medical school, which means clinical medicine. Traditionally, students complete 2 years of "preclinical" years consisting of physiology, pathology, pharmacology, etc and then transition to "clinical" years for year 3 and 4 of medical school, where they learn to apply those basic science principles before becoming official MDs or DOs.

During the first two years of medicine I struggled with many things. Foremost among these was the type of thinking required. During college, I knew I had an excellent memory. Sadly, I studied very little in my life until college. I went to a typical southern public high school, where I made mostly Cs and Ds, spending half my day at the Fine Arts Center doing drawing, painting, and ceramics. The rest of my day was spent running and lifting weights. As a senior I was the state champion in the 2mile, and had scholarships to run in college. Then, as a freshman at Brevard College in NC, I recall studying for 2 hours before a psychology test and making a 100. Afterward I thought - man, what a big investment but it paid off! Little did I know most people studied much more than this throughout their lives and in college. Upon transferring to Furman University in SC for my sophomore year, I learned to really study.

And from then on, I made all A's as I would study an hour or two each night and then cram 2 hours of facts in my head at 5am on test days. Little did I know my classmates were studying much more than this and really learning material. I instead spent a great deal of my time training and well, frankly, talking to people! I also drifted more and more toward the lab and coaching athletes.

In the end, I decided to pursue a Masters degree in Education at Furman while teaching high school, then moved to Auburn Alabama to work on my PhD in LB Gladden's lab on lactate metabolism. When I arrived at Auburn I had not made a B since my first year at Furman, and I never made a B again through the courses at Auburn. However, I soon realized that memorizing facts contributed very very little in the research world. In fact, it became apparent that many researchers would say I was waisting my time memorizing lists of information, and I soon came to see how right they were. Often in the lab it was an idea or connection between ideas that changed the course of experiments, not a list of facts. In fact, I soon learned that the “very best” in research world were not the best memorizers, but were a different breed of flexible, creative, “out of the box” thinkers that seemed to be able to integrate ideas and concepts in such a way that new original ideas were generated. I was impressed with Mike Hogan from San Diego early in my career as one of these people.

So when I arrived at Medical school, I was continually disappointed with the lack of depth with material. Rather, we would have 1 week to cover a very broad topic (say cardiology) before moving on to the next topic. Often my grades suffered most in the blocks I was most interested in. I made a 67 on the heme/onc exam, mainly because I was reading articles on the nuances of bone fibrosis in diseases such as polycythemia vera (which my mother has), failing to memorize the mundane lists given to us. In fact, often times learning was not encouraged, memorizing was. I find it a dangerous place where facts are memorized with no understanding of the process.

Even as we completed year 2 and took our first medical certification exam, I was amazed at the great emphasis on factual recall, NOT patient care or problem solving. Often times patients complain of two things: doctors being cold and not caring and (from the brighter patients) doctors not being very curious or good at problem solving. Both are a direct result of how we select our doctors and then train them. This needs to change.

With two years and a board exam behind me, I was ready to hit the floors. But what awaited me turned out to be less about medicine or science and much much more about other things. Enjoy my account of these years; please note that names and places may be altered to confine to patient confidentiality. Everything else will be as true to my experience as possible.