I was walking home from classes last week when I ran into a few friends from my medical school class sitting outside at a local bar. I was done for the evening, so I pulled up a chair, ordered a beer, and joined the conversation. They were talking about the wards. I’ve been on a year off since we’d all been third-year medical students together, so it was fun to catch up on all of the hospital stories again. But the tone felt a little different this time.

“And then X specialty consulted because their patient was a diabetic. I mean if you can’t take care of diabetes why even have an admitting floor?”

“At least they admit their patients. If Y can find any medical problem that doesn’t fit their specialty, they turf.”

“Ugh, but Z is the worst. I’m pretty sure they’re so grumpy because they get worked to the bone day and night. I’d never do that.”

“Yeah I’m glad I’m not doing X. I want to know how to care for my patients.”

And so it continued. Quite a bit of criticism towards the various medical and surgical specialties, and very sweeping generalizations about what they do wrong and why. I don’t think this conversation could be blamed on a particularly irritable group of friends, either. I’d heard this rhetoric plenty from nearly all of my classmates; I’ve even chalked my own frustrations up to “their specialty” before. But how could this already be happening? We’ve barely chosen our own specialties, not even yet matched, and already we’ve built these stereotypes in our minds for what the other specialties look and act like. And there’s already antagonism being generated towards those archetypes.

I’ve got a little theory. Choosing a specialty in medicine, and landing your first job, is a rather peculiar process. We do so relatively early in our careers, before having done any real work in the field like you might see in other professions. Then, we commit to that specialty for the rest of our working lives. Just like that. No horizontal movement. Now, there is good rationale for that process. Training for these specialties is lengthy and taxing, and the skills from one specialty don’t always translate to another. But it does have some interesting implications on how I’ve seen students react to the process.

You need to be pretty damn sure about your decision when you make it, because there’s little, if any, chance of turning back. Most students work out their decision during the third year of medical school after a really enjoyable experience on a rotation and reflect upon the positive experiences they had as justification. But as they rise to their fourth year, start interviewing for residency positions and form their rank lists for the match, the permanency of this decision begins to set in. This understandably causes anxiety, and so students look for ways to really solidify the decision. In doing so, many will remind themselves of what they didn’t like about the other options to really vindicate their choice. It’s basic rationalization, a reasonable defense mechanism to handle the immense anxiety that comes with making a permanent and life-defining decision.

And so for months, we solidify our choice by remembering why we aren’t doing that, until what began as an internal rationalization creeps outward into our interactions with peers from other specialties. It becomes easy to lay blame for undesirable events on another physicians’ background when we’ve got all these reasons that their specialty isn’t “the best one” in our minds, and the “us-versus-them” mentality starts to blossom. This mentality invariably compromises collaborative care and threatens our ability as physicians to optimally take care of patients.

It’s important, then, for us as medical students to recognize, as we embark on our journeys, that we’re all on the same team. The same way the quarterback, receivers, and linesman are all trying to get the ball into the end zone, every physician and surgeon in the hospital is trying to optimize the patient’s health at the end of the day. This might lead to disagreements between specialties about how that goal is achieved, but the goal is the same. And it’s important to blur the lines that separateyour specialty from their specialty so that the collaborations that need to happen to achieve that goal can happen. Part of that is letting go of the internal rationalizations that we’ve constructed to make ourselves secure in the decisions we made about our careers. Only then can we truly cooperate with each other to provide the best care for our patients.

Ramin Lalezari is a medical student who blogs at the American Resident Project.

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