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May 5, 2006

How Hard is Medical School?

I found this question in my site statistics. Someone had typed that question into a search engine, and one of my pages came up. It's a tough question to answer, because it's relative. I mean, really, hard compare to what? Compared to qualifying as a tactical action officer in the Navy? Well, not really, but then, that didn't take four years. Harder than labor? My wife assures me med school isn't that bad, but that labor only lasts so long, though I'm sure it must seem like forever.

"Medical school isn't hard, there's just so much of it" is what all the docs told me before I started. I tend to agree there. My rule is there are only two things in life that are really hard, rocks and quantum mechanics. If you can wrap your head around quantum mechanics, the rest of your life will be a little different. Most people can't do it. 5000 people a year graduate with bachelors degrees in Physics from American universities, while the US produces 16000 MDs a year. So I'll agree, in that sense, medical school just isn't that hard. There's not a lot of conceptual 'wows', moments where you get all tingly because you just realized some deep truth that can only be spoken in the language of math.

Physics, however, is a very deep sort of learning. People talk about reaching up to the stars and diving down into the nucleus. Its a foot wide and a thousands of miles deep. I used to think of biology as a mile wide and a foot deep. It's got a limits. Biologists, biochemists, doctors, just don't care much about quarks, and the parking garage doesn't have many enzymes running around. It is, however, more like a 1000 miles wide and 1000 feet deep. Volume, volume, volume. The scope of medicine encompasses air quality in the parking garage and the quantum spin of hydrogen, the decay of which causes the electrons to emit photons that make magnetic resonance imaging possible. And everything in between.

I would caution those approaching medicine from business, the social sciences and humanities. Come on in, plenty of room, but the core skill developed in the training of business people, political analyists, and book critics—defending a position or selling an idea—isn't the ultimate yardstick in medicine. Rhetoric really is the ultimate yardstick in politics, fiction, and sales. It is. That's cool. Nothing wrong with that. But the body is only so amenable to pursuasion. Hey, don't get me wrong, persuasion works. . . . During Hurricane Rita I was at an emergency clinic with 185 patients in a school gymnasium when I was called out at three in the morning to a woman who was hyperventilating. I happened to know from earlier in the day that she was bipolar and asthmatic. Her breathing wasn't the sort of labored, panicked breathing of an asthma attack. Not knowing what else to do, with no doctor around and a dozen people huddled around, staring, in the dark, I put my hand on her shoulder. And she calmed down. Her breathing returned to normal. She stopped sweating. Turned out she just really wanted to go home. Yeah, so mind-body-soul, biopsychosocial, moral-mental-physical, whatever you want to call it, that's true. But everybody spends their lives on the mind and soul. Doctors earn their keep in society by knowing the body, the physical, the bio-. And that part isn't particularly amenable to persuasion. It comes down to actually knowing how the body works.

Which brings us back to medicine being 1000 miles wide and 1000 feet deep. It's an ocean. You don't have to know all of it. But you will be expected to understand how things work. That's the core skill in science: understanding how things work. The basic science professors, they kind of swim around in this big ocean. The molecular biologist will lecture about the neural plaques of Alzheimer's disease and everything they say, I mean, every word, is testable, but they don't have to know if a plaque in a particular location is going to cause a deficit in sensation in the foot or make the patient extremely irritable. The neuroscientist might know that, but isn't going to lecture the next day on the physiology of the gall bladder. Doctors are the ones that know about all the systems and how they all interact. At least, that's what Joe Q. Public is going to assume when he presents with pain in his belly every time he breathes in. As will the retired colonel, the state legislator, even the pharmacologist who teaches night classes.

It's great, it really is. Because you really can know a lot of it. And a lot of people without science backgrounds do better than the science majors. But I would suspect the biology majors, the neuroscience, physiology, and biochemistry majors probably get the best preparation for medical school. If you want a sense of the level of material you should be able to understand by the end of your first year without any look-ups, (well, maybe a couple), this review article on diabetes is representative. The contents of this article were dispatched in about five minutes of lecture, and the students were expected to know all the pathways discussed, all their enzymes, the structures of the substrates and products, and their consequences on the body.

So, how hard is medical school? Well, with all those caveats, you make it as hard as you want it to be. There are really bright folks with good intentions, research backgrounds and years under their belts who struggle. There are folks who are just back from England after finishing their Fulbright scholarships and work really hard and get really good grades but might actually tank their board exams and irritate their classmates. There are slackers who can't avoid As if they try, make friends with every patient, impress every attending, and are liked by everyone. The only thing I can caution you about the last group, is, if you're not one of them, don't take study advice from them. If they don't have to study, what would they know about studying?

Posted by Niels Olson at May 5, 2006 4:11 PM

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