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Diary of an FY1 – What Medical School Didn’t Teach Me

December 2, 2014

Recently, I returned to my alma mater for my graduation ceremony. Like a myriad flock of swallows returning home after winter, I and hundreds of my peers, bedecked in long black gowns, descended on the Royal Albert Hall. One by one, we were recognized as outstanding graduates of an outstanding institution. The rest of the day was spent catching up with friends seldom seen since real life began, comparing anecdotes about how hellish it is to be a junior doctor, always trying to one-up each other. Even after only a few months away, I couldn’t help but feel nostalgic as I walked through the halls of my old medical school.

Is that odd? To long for the salad days of medical school after barely four months in gainful employment? After six years, a quarter of my life, spent between the lecture hall and the library, I think it’s fair to say that I’ve been deeply institutionalized. My life before medical school is largely a blur. But my life after medical school has led me to ask some serious questions about the previous half-decade. What exactly was I learning in medical school?

That’s not to say I learned nothing. I will surely take the Kreb’s cycle with me wherever I will go. I have been gifted with a temple of arcane and divine knowledge, building on the foundations of anatomy, physiology, pathology and other important disciplines. This religion has been tested in the crucible of the ward and clinic, talking to and examining real patients.

But these days, I find myself practicing something alongside that high art. Something with much the same vocabulary but which I learnt very little of during medical school. For example, my tutors went to great lengths to explain that patients respond better when you talk to them, better still like real people. There were countless workshops and small group tutorials on communication skills with patients. Explaining procedures, breaking bad news and probing for ideas, concerns and expectations.

Talking to patients is one part of my job these days, one of the most enjoyable and rewarding parts of my job, but most of the time, I am talking to many other people whom I have never been trained to converse with. Nurses mainly. All the things that I, as a doctor, would like them to do (and they retort with all the things they’d like me to do, as a doctor). And pharmacists who persist with the patience of Job to point out my prescribing pitfalls and prove the PSA painfully prudent. Then there’s wheedling with radiologists and radiographers about what scans can be done when. The microbiology team who exist in some secret Emerald City within the hospital, knowing all about the bugs, drugs and rock and roll. And only a select number of these interactions take place face-to-face. So many in hospital are at the end of a telephone line, deprived of the milieu of non-verbal communication. Where were my telephone OSCEs?

And don’t get me started on fax machines. Or bleeps.

Medical school also has a rather limited rosta of practical skills and procedures that they require their students become proficient in. When I recently asked the radiologist the likelihood of my patient getting an ultrasound scan that afternoon, he replied, “Well, that depends on the likelihood of them being in the next five minutes,” with a subtle look. Before that day, I didn’t have a single DOPS of stealing a wheelchair from Radiology, walking the length of the hospital, collecting the patient myself and depositing them in Radiology. But I do now! The same goes for tuning radios, which a surprising number of patients ask me to do for them.

A lot of clinical experience in medical school is spent following around doctors, observing and aiding where possible. But now I have been exposed to the world, disabused of my naïve illusions, I can see that shadowing a doctor is a poor simulacrum to being a doctor. As a student, I never, could never, appreciated the bowel-rending realization that the responsibility for the patient stops with you. That a patient’s chest pain, or hypotension, or tissued cannula is more than a question to be solved with the application of correct medical knowledge. If I don’t do this now, the patient will deteriorate. I need to do this, and this, and then later, I need to do that.

Another fact of life missing from the curriculum is the ward inside your head that is constructed soon after starting as a junior doctor. A selection of your patients are transferred to this ward so that after you finish and leave work, you can continue to worry about them. On this ward, antibiotics and fluids are never given on time and the GMC scrutinizes your every action. This ward runs on a 24 hour shift, which can make sleeping difficult. This morning as I walked into work, I realized the sickest patient in my thought-ward would benefit from a side-room.

Maybe medical school did prepare me, in a rather perpendicular fashion. Whilst dealing out the medical knowledge in a straight, Socratic fashion, those six years of study and play were time to pupate and grow out of an overweight, socially incompetent teenager. Now I’m proud to say I’m a lanky, socially awkward junior doctor – how far I’ve come! This doctoring business is a lot more varied and random than medical school ever hints at. Perhaps not explicitly, but medical school did give me the chance to learn how to adapt to and seize the opportunity in evolving situations. But with all things in those hallowed halls, it was always medicine with the training wheels on, medicine in the ball pit.

Medical education begins in medical school, obviously. But there is so much emotional breadth, so much idiosyncratic width to the leviathan Medicine that, even though I have now graduated, I feel I’m only just getting started.

P.S. This blog appears in the December Issue of The Medical Student Newspaper. This is how they depict me.

Diary of an FY1

I am not this tan.

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