Learning the Culture of Medicine

One of the great things about being in clerkship is learning the things about medicine no one ever writes down or says in a lecture, but which are fundamental parts of the current practice of medicine. This is the "Hidden Curriculum" of medicine, and the overall culture - especially the common attitudes expressed by practitioners - is a huge part of it.

I wrote before about work hours and that's part of the culture of medicine that's really been striking to me in this first week. I'm adjusting to workdays that are 10 hours minimum reasonably well, but looking at those who have already made that adjustment has been extremely eye-opening, particularly the residents. Us medical students think we have it tough, but the truth is that feeling mostly comes from a (relatively) cushy lifestyle beforehand. Residents are the real workhorses of the hospital, putting in long hours that combine the stress of having to teach us dopey medical students with the stress of having to please their overseeing physicians while learning new facts and procedures.

(Consultants are a bit of a mixed bag, largely depending on specialty. Some see a huge drop in work hours once they start independent practice. Some simply see a shift in responsibility after residency. Most - though not all - work longer than the typical medical student, not to mention a bunch of "extras" they have to work on, such as Continuing Medical Education, research interests, and administrative tasks. Their main advantage is some degree of control over their schedule - while medical students and residents pretty much do what they're told, consultants can say "no" to some things)

One story from my week that hit home with me (told to me by a former clerk) was a resident who fumbled a question they thought they should have known. Not a softball question, just something they should have read up on. They chastised themselves for not working hard enough, for not spending more of their free time reading. From my understanding, this was from a resident on a service where 60 hour weeks are on the lighter side of things - 80 is more typical.

To me, that's almost the definition of insanity. How can someone who works almost twice what a normal person with a full-time job does consider themselves to be not working hard enough!? Yet, that's the culture of medicine in many pockets of the field.

Now, don't get me wrong, this is starting to change, slowly. The idea that physicians would have lives outside of medicine or limits like a normal human being used to be treated with open hostility. We've now reached a state where having a decent life outside of work is acknowledged as a worthwhile, even admirable goal, but not one that should in any way impact a physician's commitment to medicine.

Every year, we get a talk from one of the higher-ups at my school who reminds us to maintain a life outside of medicine - to have hobbies, to get some exercise, to eat well, and to spend time with our friends and family. It's a great message that this person earnestly believes and says because they want us to have a happy life. Unfortunately, these talks also tend to come with a reminder that if we don't live up to the multitude of commitments the school has impressed upon us, and if we don't make the extra effort to be a good student, there will be negative consequences. These talks also tend to come during a time when the school is explaining a whole bunch of new responsibilities or tasks we didn't previously knew we had. Kind of makes it hard to do all the "life" things they talked about.

Having a life as a physician is basically a priority that gets routinely ignored. That's a big step up from the antagonism towards a balanced lifestyle that used to exist, but it's still not enough. We've got a long way to go.