On being a Medical Student

First published here::http://student.bmj.com/student/view-article.html?id=sbmj030241 and subsequently as a book chapter here:http://searchworks.stanford.edu/view/7929525 (reviewed here:http://www.amazon.com/The-Conscious-Notebook-Narrative-Ontology/dp/1606927353/ref=cm_cr_pr_pb_t)


I had started being a medical student 40 years back and ’am part of the teaching faculty now but I still feel I am a medical student. The science is ever changing and whatever we learn today soon is washed away in a deluge of rapidly accumulating newer evidence. We tend to look back and think how awed we were by our seniors who always seemed to know so much. We thought that we too would know as much when we got to be senior ourselves. 

Many years rolled by and that moment never came, only we noticed ourselves being thought of as more knowledgeable by our juniors. Whatever we learned instilled in us, the capability to apply a rule of thumb in patient management. However, it never worked when confronted with diagnostic uncertainty complicated all the more by a dense jungle of evidence, which has grown remarkably over the years.

As medical students, when we finished the basic sciences and started clinics, there was a pleasurable difference noted immediately, as we no longer had to cram dull theory like in the basic sciences. The patient was our greatest teacher of medicine as much as the dead body had been in anatomy.

The best way to learn was interviewing the patient and going to the depths of his story, which in 75% of cases would yield the diagnosis. It was a detective game and the clues had to be meticulously elucidated. This is where our teachers played a role. They showed us how to elicit these clues, which were vital to the diagnosis. We however learnt not only plain hunting but also to love our patients. It was great to collect their stories and keep them in our mental hard discs and reflect on them over our textbooks. That was the first time we experienced our books coming alive. At a time when our contemporaries were collecting stamps, coins or people’s autographs, we started collecting people… live people who were not just long dead characters of a novel but would greet us from bus stops or morning walks. Interacting with them we experienced a vitality flowing like a river in and out of our lives.

The greatest gift however, my formal training in medicine provided, was the ability to look at the human body as a machine. I had initially instinctively rejected this mechanistic way of looking at humans but gradually became used to it when I realized it was one of the most advanced systems ever invented or evolved. In this scheme of things, off course, doctors lose their halo and become more of system troubleshooters. They can be mollified by the fact that its one of the most advanced and complex systems they trouble shoot.

However it’s peculiar how a whole health care industry manages to remain preoccupied with only one single objective day in and day out and that is system trouble shooting. We don’t develop new systems, we simply try to solve problems and keep learning from them, newer methods, and strategies to solve further problems. Very often there are problems in the system we have created ourselves in our bid to solve a few relatively simpler ones. Luckily the body in its advanced complex framework has been endowed with self-repairing capabilities. Its system of self-repair often also does lead to problems, a reminder of the fact that we live in an imperfect world.

All humans have this propensity to solve problems be it mechanical or human. There is a medical student in all of us. More often we tackle our innumerable day-to-day problems just by listening to them, analyzing them from a different perspective. This however requires time, something, which has been lost to medical students who are also, designated interns, residents or consultants.