Ten things I learned in medical school (Other than, you know, the medical stuff)

I learned a great deal during the preclinical years of medical school, much of which served me well during my clinical training (although I never found a practical use for memorizing the Krebs cycle beyond boards exams). Clinical training was a whole new world, filled with hidden lessons that I didn’t find in any of my textbooks.
10. Late is a four-letter word. Be on time; rounds do not wait for the medical student. A lot of being a third year med student is simply being there. When I was on my surgery clerkship, New York was hit by hurricane Sandy. The next day, we were all there for morning rounds. On time.
9. Residents are people, too. Very overworked, often overwhelmed people. They have good days and bad days. Offer to grab them a cup of coffee (no, they’re not supposed to send you to pick up their laundry, but there are no rules against grabbing an extra cup of coffee for them from the cafeteria). Their time is precious – their “to do” list can be insurmountable. One realization of third year was that my education wasn’t necessarily anyone’s priority; rather the care of the patients is center stage, as it should be. If residents set aside twenty minutes in the afternoon to talk about electrolytes with you or discuss the management of your patient, I learned it was a gift. Don’t forget to thank them. 
8. The only correct answer to “Would you like to. . ?” or “Could you help me with. . ?” is “Yes! Absolutely.” Consider each of these requests as a learning opportunity. Although you will have lectures about everything from ascites to X-rays, a great deal of learning during third year is experiential. This was a hard lesson for me. A perfectionist at heart, I wanted to know how to do something perfectly before doing it at all. Third year doesn’t work that way. Be sure you have appropriate supervision and then do your best. Also, realize that appropriate supervision may not be a resident. Unsure how to remove a foley? Your fellow classmates or a nurse may be able to lend a hand. See one, do one, teach one continues to be a central tenet of medical education. If you don’t take the opportunity when it arises, you may not have a chance to again – until intern year when, suddenly, you’re the doctor.
7. Always carry a protein bar in your white coat. On the wards, your care and comfort is your own responsibility. Some days, a member of the team may look at you and say, “Have you had lunch? Go get something.” Otherwise, you should recognize what you need and take care of yourself. That protein bar in your pocket can be just the thing you need between surgeries to keep up the blood glucose and perform at your best (or at least not pass out and compromise the sterile field).
6. Never be without gum and an extra pen. Medicine is a team sport and you do what you can, even if it is the little things. Sometimes, that means being the person who has the extra stick of gum when an attending asks, “Anyone have any gum?” Ditto with pens.
5. Dr. E is always watching. We have an attending at our medical school who runs one of the clerkships and seems disturbingly omniscient. Brilliant and driven, he expects each medical student to act as an intern for their patients, not just following along passively with daily notes but placing orders, scheduling follow-up appointments, and being the go-to person for all aspects of patient care. A late admission to the team on a day you’re not even on call? You better still be there doing your H&P when he swings by the emergency department well after 7pm “just to check in”. Never have I learned more or been more on edge. I hope every med school has at least one Dr. E – someone who holds everyone, themselves included, to a higher standard. If I work like Dr. E is watching, I know I will expect more of myself and do better.
4. You’re not the only one working hard. In medicine, we put in long hours (and, as students, love to whine about it). Sometime, particularly in the winter, daylight is only a fond memory, as we arrive before sunrise and leave after dark. What I found, though, was that when I left my apartment at 5am to catch the subway, coffee trucks were already parked at their customary posts, having made the trek from the outer boroughs to Manhattan where the servers would stand in cramped quarters for hours on end earning a nominal wage. I should have already realized this; my father has worked all is life managing a golf course, arriving before sunrise year round and working long hours, often out in the elements. So, yes, I’m getting up early and staying late, but I’m working towards doing what I want to with my life (Note to self: whine less).
3. Never underestimate the value of small talk. Before medical school, I never considered myself skilled at small talk. An introvert, I am not naturally inclined to initiate conversations with strangers. On planes, I put on headphones as soon as I sit down. In line at the grocery store, I smile at the checkout person but don’t typically spark up a conversation about the weather. As a medical student, however, I found many times when all I could offer was small talk, and suddenly it became incredibly valuable. One day, a resident had asked me to gather the materials for a lumbar puncture for one of “my” patients and meet him in her room. He would do the LP and I would assist. The patient, who had metastatic cancer, was alone in her room when I arrived. She appeared very small, sitting on her bed, the TV off, anxiously awaiting for “the procedure” that was to come. Of course, the resident was delayed. So we started talking. About nothing, at first – maybe it was the weather or the hospital food, but it was little more than the smallest of small talk. As we talked, I watched the lines on her forehead soften, the tightness around her mouth ease. And then the talk became far more than small – I’ve told my family this is it. I will try one more time, but then, I’m 75, I’ve lived a good life. I’m doing this one for them and then no more. No, not small at all.
2. For each patient, this is a unique experience. At first, you feel a certain level of awe to bear witness to each patient’s experience – to learn about the diagnosis and be part of the care process. But over time it changes. It is not that you care less, but that you become accustomed to illness. The hospital begins to feel like a normal place to work rather than the stage upon which births, deaths, and other life events that serve as major turning points in the lives of our patients take place. While this may be our fifth or fifteenth or fiftieth case of a particular diagnosis, for each patient this may be the event that forever changes the trajectory of their lives.
1. What we do is a privilege. Patients put an amazing amount of trust in our white coats. We need to live up to that.
Megan Riddle, PhD is an MD-PhD student in the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program. She will graduate in May 2014 and then begin her psychiatry residency at the University of Washington.