The things you learn in med school

When we talk about medical school education, there's the actual didactic material, and then there's the 'hidden curriculum.' For those not familiar with education lingo, the hidden curriculum is a set of norms or values that are imparted to students unintentionally. It is not written down. It is not testable. It is simply something learned through the process of going to medical school.

In medical education, some examples of hidden curricula are that men shouldn't go into OB/GYN, or women shouldn't go into surgery. You should have no life other than medicine. Everything comes second to your medical responsibilities. Sleep is for the weak. There's no crying in medicine.

Sometimes, these lessons are reinforced though things like lectures on professionalism or the patient-physician relationship. Some schools even try to direct their hidden curricula, taking it into the open light, for better or for worse.

For me, I found my own hidden curriculum from medical school. In the process of going through school, I learned a lot of things that med school never intended to teach me, but they're some strong lessons for life:

The friends you make over a bottle of $200 scotch at 4 AM are probably some of the best friends you'll have.

Thanksgiving and Christmas are precious, and when you can't go home for your own family's holidays, then finding a family to take you in is invaluable.

Medical school is some of the hardest work you'll do. Work hard, but play hard too.

While there are many other such lessons, the one that stuck with me is that at some point in your schooling, you will find that you will have to choose to give everything to medicine, or hold back. And you will discover what kind of doctor you really are when you're faced with the hardest choices between what you want to do, and what other people need of you.

Who you need me to be

One of the strange things about being a doctor is that I play a lot of different roles, and I don't mean administrator or physician or teacher or whatever. I mean that when I meet a patient for the first time, I try to figure out what they need me to be. Some patients need me to be a listener. Some need me to be a father. Some need me to be a counselor. Every patient needs something a little different.

One of my patients is a university professor, and what he wants from me is advice about the stuff he reads about health. Is there any truth to coenzyme Q10? Is Atkins a good idea? He doesn't want me to tell him what to do, just give him some advice.

Another patient has no clue. She comes to me without any idea of what to do next. You need to lose 10 lbs. You should cut out fried foods. When you can't breathe, you should use your inhaler. I saw one person who just wanted reassurance. He knew and I knew that he was healthy, but he needed to hear it from me. Another needed me to boss him around.

The strange thing is that I am simply me. I don't try to act like someone I'm not. And somehow, that's enough. I think that the quality that lets me do this effectively is that I don't need to be in the driver's seat of the patient-physician relationship. Tell me what you need me to be.


In order to truly enjoy something, it has to have some context. It has to be shared. That's why people try not to eat alone or go to the movies alone. It loses its context. And that is the dilemma of my life. I lack context. I have all these emotions... is it hate or love or envy? I can't quantify or measure it. It's like a commercial: it happens, it's over, it meant nothing, and it's forgotten.

When we talk about anhedonia in the clinical sense, this is not it, but I wonder sometimes if this is real anhedonia. Everything is bland and grey and lacking passion, not memorable at all.

I'm not depressed, although my friends seem to think it's within the realm of possibility. I just feel like my life needs more context.