An excerpt from The Premed Paradox.
As I had seen my senior residents do in the past, and without a second thought, I picked up the sterile gauze, folded it over to create a padded protection from the glass of the lidocaine vial, and snapped off the top as required. To my absolute shock, I immediately felt the glass tip of the vial penetrate both gauze padding and sterile glove, cleanly slicing through my thumb which had applied the pressure. I placed the vial back on the kit and looked down, horrified, as round drops of bright red blood began to emerge from the slit in my pearly white glove. I looked over to the supervising doctor who was standing behind me, and barely managed to croak out these five words: “I think I cut myself.”
I was about 10 minutes into my first-ever procedure as an internal medicine intern, and I had injured myself before even touching the patient. I had no choice: I was forced to abort the procedure, clean up, and first stop the bleeding in my finger before I could proceed with anything else. I apologized to the patient, attempting to hide my emotions. I don’t think I had ever been more professionally embarrassed.
Luckily, the patient and my supervising doctor were quite gracious. “Mistakes happen,” they said. The patient was doing just fine. “No problem, and no harm done.” Their support and patience meant more than they knew.
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Once I had cleaned and stabilized the cut, I gathered my courage and returned to the patient. I was able to start once again and successfully complete the procedure. The irony (and relief) is that everything with the patient went perfectly. The second time around, though my anxiety was heightened by my previous failure, my hands were steady. The needle passed easily into the patient’s belly, clear-yellow fluid flowing out without resistance. The patient had no discomfort, and things went as smoothly as I could have hoped for. He felt much better afterwards and thanked me for my efforts, with a bit of a knowing smile that comes with witnessing such a memorable misstep.
I have since done that procedure and others countless times during my time as an internal medicine physician, but I have never had such a humbling experience. In that moment, with that simple mistake, I had a shocking realization which proved to be an invaluable lesson: The practice of medicine is difficult and unpredictable; no matter how prepared I thought I was, I would face unexpected challenges and failures along the way. That would be a part of the process, and the hard times would probably teach me more than the good ones. In order to traverse the medical education gauntlet, I would be put in countless new and uncomfortable situations. But humility (understanding that there is so much to learn and no one can ever be fully prepared) would be perhaps the biggest lesson I would learn as a medical trainee.
Looking back on this moment of perceived failure, I was able to rely on my education and training to ultimately succeed. Having seen and learned the procedure before allowed me to regroup, bounce back from my initial misstep, and eventually execute successfully to treat the patient. This is why the “See one, do one, teach one” concept survives to this day. Education and exposure lead to experience which in turn leads to expertise. The slogan lives on in the heart and soul of the medical community because it captures our essence: embracing the challenge and bravely pushing on during tough times to master the crucial skills of healing.
If we take a step back and apply this slogan to medical training as a whole, to the process of becoming a physician, the concept again holds truth. Pre-meds also have a tendency to jump right in, to commit themselves fully, to dive head-first into their future endeavors on the way to becoming a doctor.
The medical education process is rigorous. It demands this wholehearted and unwavering commitment. I commend the bravery and dedication of anyone who chooses to pursue a career as a physician. It is an amazing but challenging pursuit, filled with experiences spanning the emotional spectrum. All pre-meds and future physicians employ a steely determination, an unwillingness to flinch in the face of difficult situations. In undergrad, med school, residency, and beyond, trainees “Do one” on a daily basis, learning new skills at a rapid pace. They eventually reach proficiency and ultimately expertise, allowing them to practice medicine with precision and “Teach one” to the generations that follow.
But there is a limitation to this approach to the premedical process, and it lies in the “See one” portion. The vast majority of aspiring pre-meds have limited exposure to the actual life experience of a career in medicine, at all stages from medical school to residency to practice as a full-fledged physician. This is to no fault of their own; this vital information is neither easily attainable nor readily accessible. The “See one” step of the premedical process is often stunted, as it is difficult for many pre-meds to find real clinical experience until they start medical school and begin a structured training program. Perhaps without even knowing it, many aspiring students commit to a tremendously challenging road without the ability to see what they are committing to, without the opportunity to understand what life as a physician is truly like.
Yet medicine is still an exceedingly popular career choice, with one of the most competitive graduate school admissions processes and more than 50,000 students applying to U.S. medical schools each year since 2015. And herein lies the counterintuitive notion which I call the pre-med paradox:
How could so many intelligent and hardworking people dedicate their lives to becoming a physician, perhaps the longest and most arduous professional path, with such little information about what that commitment actually entails?
The farther I have moved along in my medical training and now my career, the more data I have gathered to argue that the pre-med paradox exists, and the more the paradox has continued to perplex me. From what I have seen through my experience, as well as those of my peers and countless students I have mentored, most pre-meds are affected by the paradox at least to some degree; they lack a level of exposure which would truly prepare them for the career that lies ahead. Ironically, but not surprisingly, I was as much a subject in my own data set as any other individual. Despite the considerable benefit of having a physician as a father, who certainly provided me with great advice as I embarked on a medical career, I still had a relatively elementary understanding of what my future in medicine would actually look like.
I am no exception to the rule; I am a confirmation of it.
Though a medical career is a worthwhile and noble pursuit, it should be chosen carefully with sound motivations. If not, and if the individual’s expectations are not met, there is a much higher chance for professional dissatisfaction and ultimately burnout. If, on the other hand, the career choice is aligned with the individual’s values based on solid information and experience, a happy and fruitful work life is a much more likely outcome. We all deserve this opportunity for professional gratification. I feel very fortunate that I ultimately found it.
Amit Pandey is an internal medicine physician.
