Lies They Tell You About Medicine

Canada’s The Globe and Mail recently published the piece, “Think medical school is for you? You’re probably wrong.” Trisha brought it to my attention with her great response piece here. While I think the author has some salient points, I disliked the strong undertones of the piece. It did get me thinking, though, how a big part of the reason medical school turns out so different to how people expect, is because our expectations are all wrong. So this is my response, in the form of rectifying the lies we perpetuate.

“You will get rich”

No, you won’t. The days where doctors make a lot of money are virtually a thing of the past. Those who do make money are the ones who specialise, research and set up private practices – preferably all three – for which you NEED money. Combine that with the many years it takes to attain your qualification, the exorbitant tuition fees, the many hours overtime and the meager allowance of paid leave, and the salary really isn’t all that hefty. This is not to say that you’ll be poor though: you’ll certainly have a stable income, and you’ll never want for a job. But if it’s income you’re after, there are many other jobs that can give you the same or better income for half of the pain and suffering.

So, if the financial argument happens to be one of your biggest motivators for being in medicine, I’m not here to tell you that you should feel guilty about it. I’m here to tell you that somebody lied to you.

“You will be respected”

My parents’ generation and older have a real admiration for the medical profession. Our family GP could probably get my dad to do anything, because he respects his judgment so much. I’ve realised more and more that it is not the case any more. I have witnessed some seriously competent and NICE doctors being treated like crap by patients. A lot of it can be ascribed to the belief that respect should be earned (which is one I agree with, by the way) and the trend to move away from hierarchies. In South Africa, many patients seem to think they are owed better treatment than the person next to them. This post by an American surgeon indicates that a blatant lack of common decency towards doctors is not an isolated phenomenon.

“You will change the world”

Many people choose med school because they want to “help people”. As anyone with half a brain knows, many other professions HELP people. But we have this desire to change the world, to save lives, and somewhere along the line we started thinking that the best way to do that is to be a doctor.

The harsh reality: you probably won’t save the world. You probably won’t even really change it. If you leave, some other doctor will take your place. Some other doctor will prescribe life-saving treatment. Some other doctor will resect necrotic bowel. And even if you are working on ground-breaking research, there is probably another team on the opposite side of the world working on the same thing.

Allow me to be a real cynic: not even Chris Barnard really changed the world. Yes, he pioneered heart transplants. So he changed the lives of the people who need new hearts, and their families who won’t have to say goodbye just yet. He changed their worlds. But THE world? Probably not.

“Med school is the easy way out”

What makes med school – and the subsequent career – hard is not just the work (which is voluminous) but the interplay of various factors. It’s not just the body and what goes wrong with it. It’s the social setup of your patient. It’s the meddling of politicians and bureaucracy that constantly derails your good intentions. As for the certainty Sinclair talks about so casually? There is very little certain about the medical life. Where do we specialise? Where do we work? Where will a computer algorithm decide to send me for four years of my life? Will my patient sue me today for not smiling big enough for him? What will the government’s next way of meddling with my practice be? Will I be attacked by a psychotic patient? Will I be exposed to a lethal virus?

Does that truly sound like such a secure environment?

“Med school is hard”

Seemingly contradictory? A lot of people choose not to study medicine because they think they’re too stupid, while others choose medicine because they mistakenly believe that it is the only field that will keep them mentally stimulated and challenged for the rest of their lives. The truth is, med school admission is not a perfect process, and I have seen that many of the kids who were not the brightest in high school are often the brighter ones in med school classes. My point? If you’re assuming something, you’re probably wrong. As much as medical students tend to act like high school students, med school is NOT high school.

“You can still have it all”

You probably can’t. This doesn’t mean that you have to choose between career and family (don’t let ANYBODY feed you that lie), but the sooner you realise that there will be tangible sacrifices involved, the better. When you’re applying to med school you probably get excited about the idea of 36 hour calls, but when you’re in the thick of it you will feel miserable at least some of the time, and feel jealous of the patients who get to sleep and have nurses faff over them.

“It either is for you, or not. There is no in between”

A lot of heartbreak could be averted if college applicants realised that their happiness does not wholly hinge upon their career choice. Sure, if your numeracy skills are atrocious you probably shouldn’t study actuarial science, and if the thought of blood makes you squirm you should probably stay away from any life sciences, and so on. But very often, we have some very divergent career options and we get so stuck on the idea that only one of them can be the right one, and then when we are having a hard time in our chosen direction, we become convinced that we have made the “wrong” choice.

“Medicine is not a job: it’s a calling”

I understand the sentiment of this statement, but I also think it’s one of the most damaging statements because it gives rise to a lot of assumptions. For example, the fact that so many doctors are expected to work in absolutely horrendous conditions can probably be at least partially ascribed to the belief that it should be a CALLING. It leads people to expect that doctors will make things work somehow, no matter how haggard the conditions of their hospital. It also lead to the the systematic door-matting of doctors, because hey, if it’s truly your CALLING you won’t complain, RIGHT?!

“If you’re not 100% passionate, you shouldn’t be a doctor”

Continuing from the point above: why are only docs held to this ridiculous standard? Wouldn’t the world be incredible if EVERYBODY was expected to be passionate about their work ALL THE TIME? I tell you something: it would also be a world full of incredibly burnt-out people.

It’s not fair to expect of others – or, heaven forbid, YOURSELF – to be this kind of superhuman. And honestly? If dealing with difficult patients or the social determinants of health does NOT make you feel a bit disillusioned, you probably need your mental state evaluated. Like, by a psychiatrist.

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Do I sound like a little cynic? Maybe. The truth is that I get a lot of questions from med school hopefuls about whether MEDICINE IS THE RIGHT CHOICE. And I often feel that I just don’t have the right answers because the decision is multifactorial. It has to be, otherwise you’re doing it wrong. A step in the right direction is for us all – parents, guidance counselors, the public, and doctors themselves – to stop perpetuating these lies.

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Some additional reading:

A very honest journal post written in my first year

Exploring the brain drain into medicine

Why you shouldn’t go into medicine by A Hopeful Doc – in my opinion one of the best posts written on the topic, and actually not cynical at all.