Things I Didn't Realize About Medicine Until I Became a Physician

Last Updated on March 12, 2019 by

Recently SDN member medinquirer noted that it’s common for premed students to learn about medicine through shadowing, volunteering, working in related fields, etc. But surely, said medinquirer in his post, there are things you don’t realize about medicine until after you become a full-fledged, practicing physician. What are those things? Here are some of them of them, as shared by members of the SDN community:
No one teaches you about billing, prior authorizations, etc. until to have to do them. There is no real “education” in those endeavors, but they are part of the system and a requirement of the job.
• Stereotypes as specialties are true to a large degree.
• Chasing money will lead to a fat bank account but also rip your relationships and moral to shreds.
• The stress level was much higher than I anticipated. I always had my attending as back up till I was on my own as an attending. The learning curve from resident to attending was the largest one by far, with med student to intern a close second.
• I lived frugally and am reaping the benefits. My friends who took out >300k in debt are having a hard time figuring out if they should even consider buying a house since they have so much debt.
• The doctors’ lounge has free food all the time!!!
The most significant thing for me was the sheer volume of medical conditions and patients we are unable to cure, but rather patch up and move along. I think most premeds (or maybe just me), only went to the doctor for acute “fixable” problems such as strep throat, and thus, have this impression that as a doctor people come to you with a problem and you give them a solution and they walk out relieved. In reality, that’s not the case for most specialties or patients.
• So much of inpatient medicine has nothing to do with medicine. It doesn’t really take an MD to look after a demented patient until a nursing home can be found, yet our society lacks an alternative and so you end up babysitting them for weeks at a time.
• Most patients have never even learned the basics of their chronic medical conditions. You’ll be confronted with end-stage COPD, congestive heart failure, etc. patients who have absolutely no clue about their horrible prognosis. The patients and their families are often surprised to hear how sick they are once they get hospitalized.
• People in other fields of medicine know laughably little about proper management of patients within your field. Unfortunately, this also means you don’t know much about management in their fields.
• You are guaranteed to run into people completely unqualified to do your job who think they can do it better than you.
• Medicine/training can and likely will change you. Sometimes for the better and sometimes not, but it will change you. Especially in this last year I’ve found myself more stressed than ever and getting a temper I’ve never had before and have had to really learn when and where to speak up about an issue that matters and when not to. I know that’s vague… I significantly underestimated, and honestly had no idea about the amount of stress that can occur
• The politics inside a hospital can be absolutely horrible, whether it’s between the administration and clinical staff or amongst physicians/groups.
• Don’t take anyone’s word for anything… whether it’s another doc, a nurse or whoever. Verify for yourself or you can get burned.
• Listening and communicating well and having a good bedside manner will make you a star in your patients’ eyes. You don’t have to spend 45 min with them, but actually listening and responding goes a long way, even if you have no idea what’s going on.
• Having a truly appreciated patient hand write a letter of gratitude to you can make you feel on top of the world….. those moments just don’t come often enough.
• You’ll get comfortable doing procedures and interpreting things that you would not have thought possible just a few years prior.
• Making the diagnosis is often easiest and fastest part. I had anticipated a little more Dr. House-style sleuthing (maybe without the breaking and entering), but in reality, the diagnosis is obvious within the first few seconds of the encounter on most occasions.
• Medicine practiced really well is and should be fairly “boring.” When things start getting crazy and exciting, it usually ends badly for the patient. Good medicine is seeing the patient early and recognizing the signs of impending doom while they are still nice and stable; the PEA arrest and emergent airway later may be more exciting but usually means the patient either dies in front of you or six months later in an LTAC with a trach/PEG.
• Writing is a much bigger part of the job than I knew. Whether it’s documentation or papers or just communicating with people, I find myself doing a lot of it.
• I use more of the skills on a daily basis that I learned as an artist than what I learned in medical school. That ability to read people, to listen powerfully, to improvise effectively, to teach and tell a compelling story–that is a big part of the job
• We don’t really allow ourselves to be human. It’s not uncommon to have people at work throwing up between patient rooms or working with pneumonia and almost passing out from low O2 level because it’s a huge inconvenience for coworkers when you call in sick. Plenty of days involve not eating or using a bathroom from 6 am to 9 pm because there are patients that need to be seen, and you feel guilty making them wait.
• Your patients’ nurses will make or break you. They are your eyes and ears on the floor, and you have to be able to trust them… They will either back you up to an attending and patients or throw you right under the bus in front of either. Learn who to trust and who not to, but be nice regardless.
• You will get jaded. Especially when you haven’t had a decent night’s sleep in weeks and you’re seeing an ER full of screaming families and melodramatic patients who think their unchanged abdominal pain for the last 3 years justifies a full workup complete with consultants and MRIs at 3 am. But a genuine thank you or a compliment from a patient or their family (though few and far between) really can make everything worth it again.
• I never thought I’d factor lifestyle into career choice, but there’s something to be said for a 9-5 specialty after years of exhaustion.
• Communication is the mark of a great physician. It doesn’t matter how intelligent you are. If you can’t make the patient understand their condition and what needs to be done, they will have bad outcomes.
• No matter how great your support staff is, you will wind up wearing many hats. Even if you don’t really have the time to do it, you will be tracking down blankets and juice cups now and then, playing chaplain to a grieving family, playing social worker trying to find someone placement. You’ll get further in your career if you lose your ego and the phrase “that’s not my job” right now.
• The media, your family, your friends, and your patients outside of the medical field will all have an idealized view of what you do.
• Patients, especially ones from low socioeconoic status families, are jaded by medicine. Most will not believe you have their best interest at heart. It will take a lot of time and effort to try to change their minds, and it’s tough to accept that many times you won’t.
• I never realized how much I’d have to study/learn in residency. It’s like medical school, with less time.
• It’s hard. It’s easy to say “I’ll take it!” but then you get in the thick of things, and it’s HARD.
• I didn’t know what a PA or NP was before starting residency. I didn’t know that the vast majority of physicians don’t think/function like they do in major academic centers/at universities/at residencies.
• Business and compensation are driven by referrals.
• Nursing staff and ancillary staff are the eyes and ears on the ground, not residents. Developing a strong working relationship with them is incredibly important if you want to excel.
The biggest thing I’ve learned/had an affirmation of is:
I work in an office with excellent staff that follow their job descriptions. I get to see patients who trust and like me. I’m so glad I made it through because I am finally happy.
Have you read a thread in the forums containing excellent advice you would like to see featured on the SDN homepage? Submit it to [email protected].