The end of my residency and beginning of my practice was the most wrenching experience of my life.  I was woefully prepared for the transition.  Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes.  Things have changed considerably, but the psychological passage I endured still holds.

I think my process of becoming a surgeon was fairly typical, with the exception that there was no one in my family in the medical field.  All the doctors in my family, including all my siblings, are PhD types.  So through basic education, I was generally the smartest in my class, with all the baggage that entails; especially an growing up in the streets of New York.  Socially ostracized, socially inept.  Family outings were things like a Sunday drive to West Point to watch the Military Band concerts.

Then off to an Ivy League School to enter the contest for medical school admission (only 10% got in in my era.)  Not really difficult, but did involve a lot of studying.  I had 8am Saturday classes every semester.  No Friday night parties for sure.  Acceptance to med school upped the ante.  Now it was time for serious studying and ridiculous memorization; most of which has since become outdated.  All to get good grades and a good match for residency.

Then off to another hospital for residency, where you are treated alternately like a slave, and a social reject.  It has now been essentially your entire adult life with no training in any of the social sciences and the art of human interaction, and minimal normal social interaction.  The hierarchy of hospitals could only be called normal in the military.

Then you finish your residency and move to a new practice, and when you walk into your new hospital, you are afforded God-like status.  Where in this process is there any time or training to become a social, reasonable individual?  You train for years to be as perfect as possible, and then are damned for being a perfectionist.

In addition, I had a problem that compounded my difficulty.  I have no memory of ever wanting to be anything but a surgeon.  When at age 9 I broke my arm, I told the surgeon who treated me that I was going to be a surgeon when I grew up.  He responded condescendingly.  So now, I was a surgeon … what to do with the rest of my life?  What goals to strive for?  A very heart-wrenching experience indeed.  It took me over 5 years to get my head even partially screwed on straight.

Medical schools should offer courses in negotiations.  I took one at a law school, and found it very helpful.  Also human growth courses are also helpful.  My favorite place to go is Esalen, though I haven’t been there in years.  Any intensive course, taught by a competent psychologist will be helpful.  Learn how to interact with people and separate your professional perfectionism from your social realm.  Become a part of your community.

Paul E. Smith is a surgeon.

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