Deciding What to Learn

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.