This has not been an uncommon occurrence over the past 2 1/2 years.  In my bed with my laptop when I should be asleep, looking at blogs, taking quizzes, checking out stats on different specialties to find my place in this crazy world we call medicine. This wouldn’t occur all the time but enough that it was noticeable and something I clearly wanted resolved.

On these nights my thinking started out semi-logically: Get a good night sleep to be well rested for tomorrow, seemingly not the most difficult plan to follow through on. As I lay in bed, though, I began to have this insidious onset of the following constellation of symptoms: palpitations, diaphoresis, shortness of breath, and feelings of impending doom.

Were those hours of sitting in the library finally catching up to me? Did I dislodge a clot in my leg, sending it on a one-way trip to my lung, disrupting the exchange of oxygen and carbon dioxide in my precious blood?  As I opened up the computer my symptoms began to fade; it seems I was not having a PE, an MI, an NSTEMI, or any other acronym synonymous with a fatal outcome. Like any other medical student, I was nervous about my future, or more accurately, whether I could accept my future.

You see, my perception of medical school beforehand varied drastically from the daily realities of school and medicine as I know it today. As you are reading this, you are probably thinking, “What are you talking about? How could you not know medical school would be tough? Its M-E-D-I-C-A-L school — everyone knows this.”

True and yes, I expected this, I expected academic rigor and long hours in the library, etc., and I was prepared for that.  What I did not expect, nor was I prepared for,  was the daily onslaught of protocols, survey’s, accreditation forms, 4-hour long ethics classes, and the various acronyms for memorizing concepts that would be obvious to most people with a 5th grade education.

I made it, though. Survey by survey, form by form I trudged through, managing to learn a little medicine in the interim. Now third year is here, and things will be different.  Medicine begins, school ends. I was going to be a cowboy in the Wild West, learning things on the fly, watching docs deal with complex and interesting cases, learning and immersing myself in the process.

I’m sure if one of the many cynical docs out there happens to be reading this, they are laughing now.  I’m sad to say: This is not how things have been going. As I have entered the third year, the system, the man or whoever or whatever is pulling the strings, seems to have made its prime objective for me to learn as little as possible, bogging me down with more paperwork, forms and protocols than ever before.

Contemplating the lofty ideas of the future of medicine and my chosen career path, I come back to earth and in front of me is my neurology preceptor. Completely unperturbed about what I related to him about my educational impediments.  He explains to me this experience, my experience, is not unique, it happens after medical school and after residency to most in the field.

So I urgently implore him, what do we do? How can fight this thing?  He told me I am and what I must be: subversive.

The conversation was over. We were interrupted by another form that urgently needed to be filled out. He did not have to expound or explain because in that one word he conveyed to me how to win, how to fight, how to beat the system. For those of you who stand to gain by this system, take a hard look at the directors of medicine, the chief of surgery and the administrative positions that will be hired in the next 5 to 10 years. They will have sterling resumes with the right medical schools, prestigious research experiences,  residencies, and a record of perfect compliance. Many may abide by your arbitrary rules and enforce your regulations and protocols. On the other hand, your next hire could be me. I’ve slept well ever since.

The author is an anonymous medical student.

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