Thursday, September 27th, 2012

Deciding What to Learn

Devon Taylor

Here I am, week 6 of medical school. Intro to the Profession is becoming a fond but distant memory. The Molecular and Cellular Basis of Medicine course, or MCM (what we call biochemistry), will come to an end in just a week and a half. Then, I will spend the next 5 weeks learning as much about human anatomy as I can. I’m starting to get the feeling that this medical school thing is going to be finished before I can take a breath, before I am completely comfortable with my level of knowledge. That feeling is somewhat overwhelming. As a physician, I will have people’s lives in my hands, but the word “hands” is only a metaphor, and an overly simplistic one at that. I wish being responsible for a person’s life was as simple as just holding on to a ball, an egg, or even a delicate flower, never letting it drop… never breaking it. However, the fact is that IT’S NOT! It’s not simple at all. The idea is supposed to be that I study cell signaling today so that I may save someone’s life or health 20 years from now. Is that a long time to remember something? Maybe, but that is not the problem for me. The problem is that I’m still not even close to comfortable with my level of knowledge on cell signaling, and we finished talking about many of those pathways last week. Now, I have new things to learn. So, it’s time to move on.

I probably don’t need to explicitly iterate this, but medical school is extremely fast-paced. The current body of medical knowledge is simply overwhelming to a young, and very green, 1st year medical student. A simple PubMed search for “diabetes” yields 414,545 peer-reviewed journal articles, which would literally take me 10 lifetimes to fully understand. When doing a search for the word “cell,” the results yielded a whopping 4.79 million articles! How in the world am I going to acquire the knowledge I need? How can I distinguish the absolutely essential information from the merely very important, or that from the somewhat important, or the somewhat important from the rarely relevant, which someday may prove to be essential for any one of my many patients? What may not seem important to even the most reputable experts, whom I have the distinct honor of learning from daily, may prove to be vital to saving my patient’s life in the future. I understand that my professors have to filter out the “less important” stuff (and I’m sure they’d love to teach it), but the fact is that it’s all important, or it could be. However, they only have four years to teach us. So, the question becomes what do I learn? How can I cope with my inadequate level of knowledge? How will I be able to do that in 20 years?

I can tell you that I have no clue what the answers to my questions are. I have no cure for my self-doubt. It’s absolutely frightening! This medicine thing is an extremely imperfect science loaded with judgment calls made considering only one’s own, and often biased, knowledge of statistical likelihoods. What happens to the small percentage of the people who aren’t within the norm? And to those people who have illnesses with mechanisms that I did not deem worthy of my effort to learn? They die. They become permanently disabled. They suffer immense pain. Am I okay with that? Does it just come with the territory? I don’t know, and I probably never will. What I do know is that now—the second month of medical school— is the time for me to start becoming somewhat comfortable with my very limited knowledge. I’m trying very hard, but so far, it seems to be am exercise in futility. I’m afraid my conscience may do me more harm than good. I hope that in my career I will be able to cope with the guilt associated with having a limited knowledge of the human body, despite there being an abundance of information out there. I will try to do the best that I can, but I am only a human being with a very limited capacity for storing information. That is a truth that continues to haunt me.

4 thoughts on “Deciding What to Learn

  1. Only twenty years ago, physicians where limited to books they had on hand, personal experience, or peers they could call to discuss situations. Whereas you said, thousands and millions of expert peer-reviewed articles are now at the world’s fingertips. I believe you are dealing with information overload in this new age. I’m not talking about the information overload from just being a med student, but rather the information overload that our culture has shifted to. Bringing valid fears to life knowing there might be literature that could change the course of treatments and change your patients’ lives. It is a valid fear, but it shouldn’t be paralyzing. Instead, you just need to do what you can with what you have and continue to grow and learn from experience.

  2. Great post. I can certainly relate- just took my second set of exams for anatomy (head and neck) and embryology. I’ve been pretty hard on myself about learning the material, because I was one of those mystery patients. It took 6 doctors, 6 months, and a medical leave from med school last year till I was finally diagnosed with thoracic outlet syndrome- which I have encountered in no less than 5 separate USMLE style questions during the first two months of anatomy. Frustrating to think that I could have been on the road to recovery a bit sooner if I had only made it further in med school before my medical leave- I could have diagnosed myself! 🙂

    Hope school’s going well.

  3. You must remember that all of the medical information available to you is usually also available to anyone with an internet connection. I can only speak for myself, but I have never been to a physician that I blindly and totally trusted… so I always do my online research before going to the doctor and also after, then I discuss my findings with him/her. The practice of medicine is no longer a mystery, patients are, or should be more proactive in their diagnosis and treatment options. Also, its not like you cannot do a quick online info search for patients with unusual health issues. You will be fine! Just the fact that you, unlike some doctors, can admit that you aren’t God and do not know everything there is to know means to me that you will be a fantastic doctor.

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