Most Med Schools graduate about 140 students at a time. Only one can be first. In my day grades were eliminated altogether and we didn’t have a “first” just to avoid this sort of thing. Medicine is a funny thing. You work your rear off to learn about thousands of things and then you forget most of it. I had a teacher tell me that if you remember 7% you will be a good doctor. I was a freshman in Med School at the time. I was floored. I couldn’t believe what he said could possibly be true. 25 years later I realize he was being generous.
So why do it? You have to learn it to understand the thing you learn next. It is like a long trail and you really only know the part you are dealing with right now. You can’t remember parts of the trail from 10 or 20 years ago but you don’t need to. You dealt with them when you were there and now they are behind you.
For example, to understand EKGs you have to learn about a bunch of sodium and potassium and calcium channels in membranes and how they open and close in sequence and what that does to transmembrane potentials. I knew it once. I couldn’t explain it now if you held a gun to my head. But I can read EKGs. I can’t explain them.
All of medicine is like this. The “top people” in Med School go on to do Residencies and Fellowships and some stay on top. Some don’t. Time wears on all of us. Some smart people can’t work 36 hour days week after week and the promise that “smart” person held isn’t realized when it comes to actually helping large numbers of sick people. It doens’t make them bad people, they just couldn’t do it for whatever reason. Divorce, depression, substance abuse, dysfunctional families, all this and more loom in the future for an unfortunately very large number of graduating doctors.
Medicine is about helping sick people and the best at it frequently aren’t the “smartest” for whatever reason. Medical Schools have to try to provide the opportunity for those that they feel have the best chance. Academic performance is just one predictor of that potential. Unfortunately it is about the only objective one.
This is why the speaker said “grades arent everything”. Perhaps you heard this statement from “your own perspective” and inferred something that wasn’t meant for you. You and your daughter should be proud, she earned it. You both need to remember though that she has only mastered the first few feet of the trail. Most doctors see 4,000 to 6,000 visits a year. Not all are new patients but many are. It adds up, maybe 50,000 folks over ten years. A small city. Most are appreciative, most are pretty straightforward. Some aren’t. People do die. It happens. Sometimes families blame you. It happens.
There is a lot of trail ahead of each of the members of your daughter’s graduating class and they will impact hundreds of thousands of patients in the next few years. Med School grades are going to be pretty unimportant very quickly. Don’t “get your knickers in a bunch” today over a perceived slight from the podium. Enjoy your daughter’s victory and have a few days together in the interval before the next bit of the trail. Internship is hard. Sure it is easier now than 20 years ago but it is still hard. Admitting that CHFer at 3 AM when you have been on your feet seeing one patient after the next since 6 AM the day before is brutal. Her husband doesn’t care that you can’t think and his son won’t understand that your dsyphoria is nauseating you, all they have in their mind is someone they love can’t breath and you’re supposed to fix it. Frequently the best at this is not the highest GPA in Med School. We all need to understand this. 6 months from now your daughter will confirm this for you. I am certain she will do fine and if “being first” continues to be important to her she will continue to excel.
The professor has 139 other young doctors that he is “setting on the trail” and most of them will do well, too. They have learned about potassium gates and bicarb re absorption and ten thousand other things. If they remember 7% of what they learned they will do well...
I read the other day of a doctor who had found a book written 100 years ago that was sort of an autobiography of a doctor in a small town, “Horse and Buggy Doctor” and he was astounded at what he read. We tend to “look down” on these “small town” doctors in an era that glorifies DeBakeys and other super specialists. That is fine. They have worked hard and they have earned it. The majority of patients will never meet Dr DeBakey and if he works as hard as possibly can for 50 years he can only operate on a small fraction of the folks who need it. The thousands of doctors who graduated somewhere down the curve will provide the majority of the care folks receive. They will work long hours, miss ballgames, have wives leave or husbands drift away, or worse yet marry them for their “M.D.” or “D.O.” after their names and they will have to go right back to seeing patients like nothing happened to them the next day. The ability to do this has almost no correlation with academic performance. That is what it takes to be a “good doctor”.
That’s some of the most insightful advice I’ve ever read on FR. Wow.
My own dr is one who could excel in a specialty field, but he has chosen to come back to his hometown (population less than 15,000). He cleans ears, does well-baby checks, medicates old men while they pass kidney stones, listens to menopausal women, answers calls at all hours, doesn’t let insurance dictate how long he spends with a patient. He hears not only what you are saying, but what you aren’t saying. He has a gift, and we are blessed.
I loved your post. Your comments about medicine and retention of learned information are also true about engineering (I am a EE). You learn an incredible amount of detail about many things and then it is never used again for the most part.
So why learn things you’ll never use? Two reasons- 1) to learn how to solve problems and figure things out in a rigorous manner, and 2) the information is still there and can be drawn back out at a later date if needed— you will have to relearn it but it will be easier the second time.
Again, your post was great.
With some minor rewriting, that thoughtful response could apply to just about any career. Thanks for the insight.
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This has to be one of the most honest, thoughtful responses to any thread I’ve seen in close to ten years here.
"Let us further hope that the inference was in your hearing"
I don't believe it was. Everyone around us noticed it, and my daughter mentioned it later. It hurt her that he was so dismissive of her accomplishment.
She never strived to be tops in her class. In fact, the honor came as a complete surprise to her. Rather, she worked as hard as she did so that she could learn everything possible. She, also, was concerned that something might happen and she would be needed. So, she worked doubly hard to insure that, should that happen, she wouldn't fall too far behind.
You must be a wonderful physician.