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Ending Premed Naivety: Understanding the Realities of a Medical Career

Created August 16, 2017 by Nicole Hawkins
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The only real recollections I have of visiting the hospital before college were once as a child undergoing a tonsillectomy and once as a preteen to visit my newborn cousin. Fast forward ten years or so and suddenly I was a freshman in college shadowing a medical professional and trying to decide if I wanted to commit the rest of my life to medicine. It was the first time I really saw medicine for what it was, and it was nothing like I had imagined.

As someone without any relatives or close acquaintances in a health profession, I grew up with a lot of misconceptions about medicine as a career. Like many of you, I will be the first in my family to attend medical school. On many fronts, I have had to discard my preconceived notions about medicine for an understanding borne of proximity and experience. Before beginning the premed journey, I was blissfully unaware of two components of the medical field: the realities of daily work and the lifestyle demands.

The first time I shadowed, I spent a few hours in the Surgical Intensive Care Unit observing a nurse. Very quickly, many things stood out to me as disharmonious to my preconceived ideas regarding medicine. First, I had always pictured hospitals as full of young, overall healthy patients who were temporarily waylaid due to interesting, rare, and acute conditions. Thanks to television medical shows, I subconsciously expected each patient to have a dramatic case (with a “zebra” condition) and a subsequent victorious recovery. I even kind of thought that patients automatically would be kind, grateful, and fun to interact with. To my surprise, I found that the wards held mostly elderly and/or chronically ill patients. Their illnesses seemed decidedly unexotic–hypertension, diabetes, dyspnea. Resolution to their conditions came about through seemingly mundane and unexciting circumstances, accomplished by pharmaceuticals and intravenous drips instead of as the result of a superhero display of intelligence and bravery by the physician. Sometimes, patients reacted angrily and interacted rudely with staff. This all quickly sapped the “glamour” from my perception of medicine.

I also had always pictured hospital work as largely composed of exciting interventional procedures and meaningful patient-physician interaction. Instead, I abruptly found that electronic charting consumed large portions of time. Certainly, procedures and rounding filled sections of the day for the employees, but the length and intensity of these were lacking compared to my high expectations. I was dismayed to observe that a nurse didn’t move alone on the SICU, but instead moved in concert with a massive stand housing a laptop that allowed for portable documentation. I’d never even heard of an electronic health record before and I couldn’t see why every patient needed so many details charted with such high frequency. Dreams of running codes, inserting chest tubes, and delivering a baby in the parking lot gave way to fears of a bleak future where I had to sit at a computer typing in what time Mr. Jones was given his Tylenol. My first day in the hospital left me with qualms about whether I ever wanted to come back.

Sometime later, however, the initial shock wore off. Something compelled me to continue considering medicine, so I returned, newly equipped with a realistic outlook on hospital work. I found myself working to appreciate medicine despite the disparities between reality and my glamorization. I observed a vascular bypass and was exhilarated that simply rerouting blood flow around a diseased vessel gave life back to a discolored foot. Sure, there was charting that needed to be done by the OR staff. There was certainly monotony in the tedious minutes spent stitching up skin. But now I began to appreciate that amidst the mounds of required protocols and paperwork, patients’ lives were being improved. As I continued shadowing and volunteering, the patient population did not suddenly shift away from the elderly and chronically ill, but I began having meaningful interactions with the patients and came to appreciate their diversity. More so, I came to appreciate the suffering of the patients and their unique life experiences regardless of their age or condition. Authentic interaction overcame disenchantment. I won’t deny that the idea of adrenaline-inducing, television-style medical drama still appeals to me on some levels, but as my naivety regarding the realities of daily medical work were removed, I began to understand and appreciate medicine more deeply.

My parents are some of the hardest working people I know. However, as they are both educators in academia, I grew up with naive perceptions of not only the realities of medical work but also the lifestyle demands. My childhood was filled with observing lesson planning, paper grading, and other general academia-related activities. Educators (like several other professions) stereotypically are “on the clock” Monday to Friday during business hours; night shift does not exist. I entirely understand that these professions put in numerous overtime hours and enormous effort towards their work, but my parents were almost always home for dinner. They attended almost all my and my brother’s sporting events in high school. We took family vacations together during Christmas break, spring break, and summer break. I grew up thinking that this kind of lifestyle automatically translated into other professions; just substitute the career “topic” for something else and keep the lifestyle. However, I was in for a rude awakening when it came to medicine.

Of course, I wouldn’t claim that the lifestyle of a scribe compares to the lifestyle of a physician, but becoming a scribe in the Emergency Department my junior year of college was the closest taste of the lifestyle I could get as a premed. By that time, I had several shadowing and volunteering experiences under my belt. Even though I was now better aware of what daily medical practice looked like, I’d amassed only about 90 hours or so of exposure in the past year and a half. As a scribe, for the first time I was about to live and breathe what working in medicine was like.

You could say it required something of a steep learning curve at first.

I’d never comprehended, personally or through secondhand experience, the fatigue (and even burnout) of working five to six days of ten-hour shifts in a row during school breaks. Most of the shift I was on my feet zipping around the department at the helm of a computer on wheels, affectionately termed a “C.O.W.” Not once in my life had I intentionally stayed awake from 10pm to 8am, much less asked of my brain to form intelligible paragraphs to document History of Present Illnesses and meticulously complete charting while I was more asleep than awake. For the first time, my work pattern did not follow a prescribed formula of lunch break at this time for this duration and then clock out at this time. Instead, lunch breaks were often scarfing down food whenever the patient flow happened to slow down and then getting back to work. Holding your bladder and running to the restroom in between going to see patients became an art form. Physicians didn’t often actually ask us to stay overtime, but clocking out became a more flexible variable because we tried to stay if work still needed to be done. I’d known that medical professionals continue to staff hospitals during holidays, but I’d never personally paid the price of leaving my family behind to go into work on Christmas Eve until then.

These strenuous lifestyle factors are not unique to medicine, per se, when considered individually; many demanding professions or night shift jobs have similar challenges. And to be fair, not all specialties of medicine lead into particularly strenuous lifestyles. However, as a generalization, medicine is often a demanding career. Perhaps it is the intense combination of all the challenges at once as well as the life or death gravity that makes it so unique. I simply had no framework for what it felt like to work in the medical profession until I got inside for the first time, and I’d guess there are likely many other premeds who could say the same. These thoughts are not written to complain about the demands of medicine; rather, they simply represent the gradual dismantling of naive perceptions regarding a medical career that must take place to support a continued path towards becoming a physician. Only then, in place of naivety, can a more mature knowledge be borne. Only then can we begin to understand what it means to work with the motto “patient first” while aware and accepting of the cost to our own lives.

Despite the harsh lifestyle at times, I also got to witness and partner with physicians through some powerful moments in medicine. The kind of moments that draw us to medicine in the first place and keep us motivated once we are in–a successful code on a father gone into asystole, the stabilization of an infant, code strokes caught in time for intervention, a trauma protocol run on car-accident victims. And then there are less dramatic yet still touching successes as well, such as seeing a patient who arrived afraid and angry leaving with a sense of calm and courage. Just as the negatives of medicine were more poignant than expected, so too the positives brought satisfaction in greater measures than expected.

Certainly, with each stage of medical training, more layers of misconception and naivety fall away. Each level of medical training (pre-clinical years, clinical years, residency, and then attending) brings with it new understanding of exactly what it costs to be a physician and exactly what rewards it brings. To truly love something and authentically engage with it, you must fully know it, for better or worse. My understanding of medicine has been changed, both for the better and for the worse, but now I am ready to begin the journey.

About the Author
Nicole Hawkins is a first year MD student. She holds a bachelor’s degree in biomedical sciences. Beyond science and medicine, she also have a passion for international engagement and exploring.

Have feedback? Suggestions? Ideas for a column or someone to interview? Email [email protected]

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