Editor’s note: On August 27, 2014, Navdeep Kang died in a motorcycle accident in Maryland. He was a fourth-year medical student at the George Washington University School of Medicine. This article shall remain on in-Training so that Navdeep’s legacy may live on as part of the medical student community.
Medicine is difficult. It’s not that the road starts years in advance of medical school, taking difficult premedical courses, volunteering at hospitals or emergency services. It’s not the notorious competition and stress of simply being accepted to training. It’s not the life-consuming monster of training itself.
The difficulty of medicine is people. If you immediately thought of our patients, perhaps that’s the problem. Our patients are the easiest part of medicine. We sit down at rounds, we create an addressable list of problems to objectify and quantify a patient’s—and hardly ever do we say “person’s,”—story.
People and persons can be easily lost in medicine. To begin, we can start with the most obvious example, our patient. A person becomes a patient the moment they see a doctor. The doctor listens attentively, analyzing and organizing a patient’s story to the set algorithm of the history of present illness, past medical and surgical histories, medications and allergies, assessments and plans. By the end of the visit, if there is still a person behind the patient, it becomes neatly organized and filed under “Social History,” which all too often is nothing more than objective occupational, travel and dietary data.
It’s a cold framework, but it’s the framework which powers our clinical duties. It’s the structure which allows us to best deliver care and medicine, without subjective skew. For decades of professional practice, eight to 14 hours a day, it will dominate our every interaction with every new stranger in clinic. And this, however, says nothing of the years spent purposefully and diligently ingraining this mentality into our psyche, facilitating that transition from procedural recollection to habit.
This is precisely the problem, the difficulty of medicine. Cool analytic thought is intentionally drilled into habit. Habit lets you instantly, seamlessly, swiftly slip into practiced routine. Habit stays with you. But habit does not run by the clock. Habit, by nature, is always on.
That’s the hardest lesson of medical school. Our training sculpts us and shapes us, but it isn’t something that we simply leave in our white coat when we go home. Perhaps this is what is meant by “medicine is a way of life.” Learning that our training shapes us, as people, and what that means for the people in our lives, is hard. It isn’t because it’s hard to observe. It’s because it’s a hard truth to face.
Tireless work ethic, dedication, objectivity, selflessness and selfless compassion: qualities that define an excellent physician. But do they define an excellent friend? Do they define an excellent spouse? Desirable qualities to be sure, but most might say no. Physicians have divorce rates 10 to 20% higher than the national averages, and of marriages that stay together, they’re less happy. Physicians are at greater risk of depression, as high as 30% among newly-minted interns. Most troubling of all, physician suicide rates are more than double the national average. The void left behind each year is large enough to be filled by one or two entire medical school classes.
Scary. Frightening. Sobering, to be sure. But lessons must be learned. Without an understanding of the reality we face, however cold and cruel that might be, we cannot hope to overcome it. If our medical training teaches us anything, it is that through knowledge, understanding and dedication, the scariest demons become manageable, even conquerable. Understanding what we face helps us prepare. It becomes easier to remember to stay balanced. It becomes easier to remind ourselves of the person behind the patient. Our spark, our creativity, the things that make us human are harder to forget when we know their value. In that sense, the hardest and starkest lesson of medical school becomes a blessing. The hardest lesson of medical school becomes an opportunity to develop a rare wisdom. It’s that wisdom which makes us, less importantly, better doctors. It’s that wisdom which makes us, more importantly, better people.