Wednesday, October 22nd, 2014

What They Don’t Teach You in Medical School

Tehreem Rehman

As I write this, I am moments away from entering a new day. It’s already mid-October of my second year of medical school and in a little over ten days, my patient history taking and physical exam skills will be assessed. In several months, I will be taking the first board exam to prove my grasp of pre-clinical knowledge. In less than a year, I will be in clinic daily and directly responsible for critical parts of patient care.

It is unbelievable how quickly all this is happening. In many ways, this year so far has been a wonderful affirmation of why I came to medical school. The material, although more complex, is more applicable to clinical work. We are now engaging in case-based learning to a greater degree and I have found it so stimulating to work through the presented symptoms and lab findings to formulate the differential diagnosis. My classmate and I are now mid-semester of the new course on US Health Justice we have piloted this fall with much success—an experience that has been incredibly gratifying and humbling. Some sessions so far have hit very close to home and I felt compelled to take a break to process all that was discussed. Yet, I strive to come back with increased optimism and fervor about the role I can play in health advocacy as a future provider.

Alongside all this excitement, however, I have also been experiencing much anxiety. The piece I write now is actually a third draft I have started within the past two weeks. I first began to write on my experiences with sexism in the clinical setting but found myself overwhelmed with the narratives and research findings I wanted to incorporate. My decision to let that piece simmer in my mind was followed by a second draft on the obstacles particularly faced by low-income medical students. That piece too was left incomplete.

Writing has always been a haven for me. Words tend to flow out effortlessly, especially when I’m writing on a topic that is personally relevant. Yet, I found myself increasingly stifled as I sat in front of the computer screen yearning to get more words out. And that seemed to be the breaking point.

After I experienced my first panic attack two nights ago, my concerned partner strived to calm me down and asked what was upsetting me so much. The first words that came out of my mouth were, “I can’t write anymore.” The one outlet that I utilized to express my angst, discomfort, anger, and hope was compromised. I felt that I was losing my ability to articulate my thoughts on issues I intend to dedicate my life working on. As someone who has found herself to be increasingly observant and less willing to dominate discussions, writing has emerged as the primary means of conveying my viewpoint. If this, too, was leaving my grasp what would I be left with?

Reflecting more, I recognized that the suffocation of my writing represented the multitude of other anxieties permeating my thoughts. How could I ever compress the mass array of microbes, drugs, and other components of medical knowledge into my brain? What would be the way to ensure that I never missed a pertinent medical finding on a physical exam in the future? Would I ever be a competent doctor?

These fears have been compounded with the typical anxiety of exams. I have to keep reminding myself that as a medical professional in training, these exams will never go away. I will continuously be taking them to ensure that my license adequately reflects my knowledge of medicine and ongoing advancements in the field. Yet, how does one achieve that balance?

Can I justify my narrow focus on studying by asserting that this is the time for me to acquire the bulk of my training? What about during clinical rotations during third year? Is it justified for me to leave out crucial screenings for psychosocial factors of health and not make the needed connections with social workers, nutritionists, or legal counseling to ensure that the rest of my mandated tasks are fulfilled with the highest quality possible and without overextending my hours? Or during residency since I am supposed to be learning the “core” of my field? Aren’t third year medical students and residents the forefront of patient care at many academic institutions though? If not them, then who will take the time to advocate for patients within the clinical setting let alone mobilize outside of clinical time? I am told we will only get busier as we progress in our careers. So many unanswered questions as I struggle to find my balance.

To be continued in my next post.

About Tehreem Rehman

Tehreem Tehreem Rehman is a first year student at Yale School of Medicine.  She recently graduated from Columbia College as a John Jay Scholar with a B.A. in Women’s & Gender Studies. As a Co-Founder of Columbia’s Public Service Initiative, Tehreem was selected to be a People for the American Way Foundation’s Young People For (YP4) Fellow for the 2012-2013 academic year in order to expand the program. Tehreem has previously served as the National Chair of the American Medical Student Association’s Race, Ethnicity, and Culture in Health committee and as a National Editorial Advisor for the New Physician Magazine. She is currently a Humanity in Action Fellow through which she intends to create a multi-school platform to address institutionalized racism and sexism in the medical school admissions process. Tehreem is interested in clinical interventions for violence, addressing gender power dynamics in the clinical setting, and the impact that health inequities have on women of color and low-income backgrounds.

4 thoughts on “What They Don’t Teach You in Medical School

  1. Tehreem: Thank you for your post. I can’t imagine how busy you must be and how disconcerting it was for you when you felt panicked when you couldn’t write. It’s unsettling when we feel like we are not “being true” to ourselves. I have had these feelings many times as well and I think they will continue to surface thru out our lives because we strive to be just people (HIA style). I really appreciate all of your reflection and ability to be self aware. I think that quality will make you an excellent doctor. You have to have reflection and self care to be able to help your patients. <3 Thinking of you!

  2. Hey Tehreem. I’m a 4th year medical student. Just about to complete my Final Part 1 exams this November. I get what you’re going through, better yet, I know exactly what it is like. One thing though: It gets better. Those questions that you ask yourself don’t make you confused or less competent or inefficient. Actually, I’ve come to believe that those are exactly what will make you a better physician in the years to come. And don’t give up on writing. I know what it feels like, I started writing again only a couple of weeks back after a 3 year break. Med school is overwhelming sometimes, but once you get through the initial struggle of ‘adaptation’, it gets drastically better. Also, there is no need to fit in. You’re clearly born to stand out, so that’s what you should do. There is no pertinent single point for ‘balancing out things’. It’s different for everyone, and hopefully, you’ll find that middle ground soon. Cheers.

  3. The fear of not being able to pen down what your mind is spinning, of not being able to let the words flow out in symmetry to your thoughts, of losing the one gem that you hold so dear to your heart, can be strangling for sure. I can completely relate, not only because I have experienced the same fears, but also because as a second year medical student, I can understand how overwhelming the constant pressure of performing well in academics can be. Throw in a few ounces of self doubt and you have the perfect recipe for a disaster you.
    But we just have to keep going on. Turning away from the cloudy mirror presented by others and blindly sticking to self determination and unparalleled ambition is our only option. And the best one too. There is nothing as solid as unwavering faith and determination in the path of success.

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