Things Med School Does Not Teach You About Being a Doctor
Six years of training and you still arrive at internship knowing very little about how to actually do this job. Here is the unofficial curriculum I wish someone had handed me on day one — paperwork, hierarchy, food, sleep and the small dignities that keep a junior doctor alive.
On my first day of internship, I knew the Krebs cycle, three differential diagnoses for almost any presenting complaint, and the precise mechanism of action of about forty drugs. I did not know how to find the photocopier, where to eat between rounds, or what to say when a senior consultant told me, in front of the entire team, that my hand-written notes were 'unreadable nonsense'.
Medical school teaches you medicine. It does not teach you how to be a doctor. The two are related but not identical. There is an unofficial curriculum — practical, social, emotional — that nobody hands you and everybody assumes you have already learned. I want to write some of it down, because I wish someone had handed it to me on day one.
The paperwork is the job
Medicine is mostly clerical. Mostly. The brilliant intervention you imagined when you wrote your personal statement is twelve per cent of the day. The other eighty-eight per cent is documentation, requisitions, discharge summaries, drug charts, calls to colleagues, calls to families, and the slow shuffling of paper from one tray to another.
Make peace with this early. The doctors who burn out fastest are often the ones who treat paperwork as an insult to their education. The paperwork is not the obstacle. The paperwork is the work. A clean drug chart saves more lives than a clever differential.
- Write notes as if a court will read them. Because, occasionally, one will.
- Discharge summaries written before lunch will be twice as good as those written at 5 p.m. Plan your day around this.
- Find a system for your to-do list. Paper, app, sticky note — anything. Holding it in your head is how things fall through cracks.
Hierarchy is real, and the hierarchy you choose to honour will shape your career
Every hospital has at least three hierarchies. There is the official one — interns, residents, registrars, consultants. There is the medical knowledge hierarchy — who actually knows what they are talking about. And there is the moral hierarchy — who actually treats people, including junior staff, with dignity.
Junior doctors learn quickly to map all three. Watch carefully. Honour the official hierarchy publicly. Learn from the medical hierarchy quietly. But internalise the moral hierarchy as your model. The senior who is famous for his diagnoses but humiliates the nurses is not a model. The slightly less famous senior who makes time for a confused intern at 11 p.m. is.
Food is medicine — yours included
I have seen interns faint on rounds because they had not eaten. I have seen registrars miss diagnoses because their blood sugar was crashing at 2 p.m. The body you bring to work is your most important diagnostic instrument. Feed it.
- Carry a snack at all times. A boiled egg, a banana, a granola bar. Hunger has a remarkable ability to convert good doctors into careless ones.
- Drink water deliberately. Most hospital staff are mildly dehydrated by 10 a.m. and severely so by 4 p.m. Carry a water bottle. Refill it every break.
- Eat sitting down at least once during a shift, even for ten minutes. Eating while walking is not eating; it is fuel-grade insult.
Sleep is not a luxury — it is a clinical tool
There is a particular kind of pride junior doctors take in being sleep-deprived. It is dangerous and it is not impressive. The evidence is unambiguous: sleep-deprived doctors make more errors, take longer to make correct decisions, and have measurably worse interpersonal skills. You cannot opt out of this physiology.
Protect your sleep with the same fierceness you protect your patients' airways. On non-call days, be in bed by ten. On post-call days, sleep without guilt. The night you sacrificed for one more episode of a series will visit you in the form of the dosage error you almost made the next afternoon.
Talking to families is its own subspecialty
Nobody teaches us this in lectures. We are expected to learn by osmosis, by being in the room when a senior breaks bad news. The reality is that most of us learn by accident, often by getting it wrong on a Tuesday afternoon and being haunted by the conversation for a week.
- Sit down. Always. Even if the conversation is brief. A standing doctor is a leaving doctor.
- Use the patient's name, often. 'Mary', not 'your mother'. It restores dignity.
- Pause more than you think necessary. Silence does the work that sentences cannot.
- Repeat the key information twice, in different words. Grief is amnestic.
- Offer something specific to do next. 'I will be back at six' is more comforting than 'we will see how she does'.
On admitting you do not know
The most important sentence in medicine is, 'I do not know — let me find out.' Not 'I do not know' alone. The full sentence. It tells the patient you are honest. It tells your senior you are safe. It tells you that you are still learning.
The interns who get into trouble are not the ones who do not know things. Everybody does not know things. The trouble starts when not knowing is hidden. Hidden ignorance becomes confident error. Confident error harms patients. Honest ignorance becomes conversation, which becomes learning, which becomes competence.
On crying about it
You will cry. Probably more than once. In a stairwell, in a car, in a bathroom cubicle. This is not a sign of weakness. It is a sign of a heart still capable of sorrow. The day medicine no longer makes you cry is the day to worry, not the day you weep.
Find one or two people you can be wrecked in front of. A peer who is going through it with you. A senior who once cried in a stairwell and remembers. A friend outside medicine who can hold the story without trying to fix it. You will need all three at different times.
On still loving the work
It is possible — necessary, even — to be honest about the brokenness of the system and still love the work. To name the bureaucracy, the underfunding, the staffing shortages, the moral injury, and still walk back into a clinic on Monday morning ready to be useful.
Cynicism is the easy posture. It is also the most expensive one. It costs you the joy of the work and your patients the doctor you were meant to be. Resist it. Name the bad things; do not let them rewrite your love of the calling.
Med school taught me medicine. The wards are teaching me how to be a doctor. The two are still not the same thing. They never will be. The space between is where most of us actually grow.
