Learning

Knowledge, it seems, occurs in ebbs and flows. By the end of college, we are overflowing with facts and formulas; we can demonstrate the right hand rule, navigate the photosynthetic transformation of light into chemical energy, and describe the Wittig reaction (aldehyde + triphenyl phosphonium ylide = alkene + triphenylphosphine oxide). Then we reach medical school and realize all that memorization must be neatly stored away in file cabinets labeled "foundation." We spend the first two years of medical school filling our heads with new facts until we are brimming with eponyms and images of cells and names of drugs we've never seen. Flying through exams, we imagine we cannot possibly learn more, and no more knowledge could possibly exist. Indeed, looking at multiple choice vignettes, we see the world as clear cut and distinct; medicine is easy, we say.

Then, we shed our backpacks and don our white coats to enter the clinical realm. The third year of medical school comprises of learning a new kind of practical knowledge. How do we interact with nurses, pharmacists, clerks, therapists, and ancillary staff? How do we call primary physicians, and how do we present real people with complex diseases in several minutes? Oh, certainly in college, we understood the chemical structure of bicarbonate, and in early medical school, we learned its use and toxicity, but now, only now, do we face a blank order sheet and realize we have no idea how to write the order. We learn how to learn, where to get information, how to teach ourselves, how to glean what we can to help those we serve.

And in the last few months, I encountered the turn of the fourth year. As a sub-intern responsible for patients, I realized how little we know. Sure, I know the mechanics of diseases and the treatments. But why do two patients with the same disease have different outcomes? Why are we so unsure how long a patient with a terminal illness will live? Why are there first line and second line drugs; what causes one treatment to fail and how can we prevent that? Why do medical mistakes happen? How can we miss such devastating diagnoses as domestic violence or child or elder abuse? How do we approach ethical dilemmas in practice? How do our subconscious biases affect our thinking? How can we anticipate unanticipated outcomes and unforeseen events?

The more I learn, the less I know. If real life were textbook, we would be healthier, medicine would be cheaper, and the vagaries of judgment and instinct would no longer persist. But textbooks hardly encompass all of medicine. When applied to the real world, theory can be flimsy and our fund of knowledge a dearth of practicality. This is why research is critical. To remain stagnant is to concede that we don't know what is always the best for our patient and we aren't trying to find out. A doctor who doesn't ask questions cannot remain at the forefront of his field and does not avail himself of the toolbox that medical school has given him. This is what I've learned in medical school: learning is lifelong and there will be a point in time when we have to teach ourselves; we investigate, we think, we learn, and we teach. Research is not for everyone, but to forget its place in medicine is to lose the humility that makes good physicians good.