The other day I decided to go ahead and choose a specialty.  I narrowed it down to orthopedic surgery and cardiology.  Not only do these two areas seem so different, they are the extremes in terms of residency programs.  Orthopedic surgey is typically reserved for medical students that score in the 99th percentile on Step 1 of the Boards.  On the other hand, cardiology begins with internal medicine which is one of the least competitive programs.  Others take me as the equivalent of an undecided freshman in undergraduate school when I tell them these two areas.  It's hard for some to see a connection.  The connection comes in that I am an engineer and problems that occur in cardiology and orthopedics are engineering problems.  This is not true for dermatology, opthamology, emergency medicine, or pathology.

In any case, those plans are again up in the air after my two meetings today.  

12:15 pm. My first meeting was with a administrator from the Drew program who was checking in on how students were doing in medical school.  Surprisingly, she gave me high praised and practically called me a genius among medical students.  Her only concern was that I might become lazy.  She said I could become lazy and still pass medical school, but would hate to see that happen.  She then went on to praise my critical thinking and noted that I would be a great researcher that could change the way research is done.  I tell her thanks and walk out.

1:30 pm. I go meet with my PBL (Problem Based Learning) instructor to discuss my performance so far in PBL.  I express that my weakness in class comes from my lack of in-depth knowledge of techniques we encounter in journal articles.  I fully understood the mechanism of the techniques but knew not their shortcomings and how to criticize them.  This is especially true when researchers have designed a completely new experimental method.  He responded by saying that this was because of my wanting to learn everything in great detail, which was not needed for our class.  He then went on to say that I had immense potential as a researcher.  He commented that he knew not my career goals but that I would be a great researcher.  He then opened his office for whenever I might want to talk about my future goals.

Needless to say, I was not expecting so much praise today.  In addition, the research cloud has again been thrust upon me.  I am the student who did research for two and half years as an undergraduate.  I am the student who turned down Boston University which has the oldest MD/PhD program in the United States.  My graduate work would have been in Biomedical Engineering where Boston University is ranked in the top 3 or so.  Boston has the highest concentration of intellectuals in America as well as the highest concentration of biotech firms in the world.  After I thoughtfully turned down Boston University, I only had slight feelings that I might regret not doing a PhD.  I admit that I think like a researcher.  Not all medical students, even those that do research, think like a researcher.  Months earlier, I did dispel the notion that just because I was good at doing research that I had to do research.  After today, it seems like others seem to think not just that I could do research, but that I belong in research.  Considering that the option of doing a PhD here at UCLA is just a matter of if I decide to or not, I now have to again deal with the research issue.

The first lecture this morning covered cell injury.  The process can be reversible but can reach a point of no return if a cell is severely injured leading to cell death.  Students kept simplifying different enzymatic pathways and inquiring about the universality of all that was presented.  The obvious answer is that everyone is different and whether something is fatal in one individual might not be for another.  Yet, some students couldn't seem to grasp this and continued to ask questions that would get them no where.  This prompted me to stop paying attention to lecture.  Instead, I pondered the concept of individualized healthcare.  Contrary to anyone's claim (that includes doctors, politicians, and media), there is no individualized healthcare.  Whenever you present yourself to a physician, all of your symptoms are combined with the doctor's experience.  The concept of 'you' doesn't exist.  A doctor develops a course of action based on his/her experience.  This seems to be ok for the common cold, but is well-known by patients with more serious health issues.  There are select doctors that are seen as the best neurosurgeons, plastic surgeons, and oncologists.  The reality is, they are the best.  But they still don't provide individualized healthcare.  They have greater experience and are successful more often than not with procedures.  Whether a person has a cold or a failing kidney, no doctor can tell the patient what their outcome will be.  Doctors are playing an odds game based on their experience.  With computational modeling such as those I created as an undergraduate, we can move towards individualized healthcare.  For example, we could model bypass surgery and quantify for a patient exactly how much more blood flow they can expect with the surgery.  This is individualized healthcare.  It is not saying, "Mr. John Doe, most patients have better coronary flow with a bypass" and then hoping Mr. John Doe fits into the 'most patients' group.

I quickly killed that thought and accepted that there wouldn't be standardized healthcare anytime soon.  This came from the rather large number of students talking about meaningless topics outside of medicine.  Others were paying even less attention.  One of our PowerPoint slides was of a finger that had been cut off.  One student decided to draw on it and make a dinosaur out of it which he showed to students immediately after lecture---none of which laughed at his drawing.  It would be great for future patients if these students were already at the top of their game.  There are quite a few students who know their stuff, but they are deeply focused with the lecture.  I happen to know these students aren't that bright by the level or lack thereof in their many questions.  They hold up class because they are stuck on slides when they do attention.  The lecturers always pretend to not know their question so they repeat a couple words about the slide and move on.  Occasionally they'll say, "I think I will answer that question by the end of this lecture, and if not, come see me."  Who knows what type of doctors these particular students will be.  Their level of responsibility, however, lets me know that in fifteen years there will still be top doctors, good doctors, mediocre doctors, and bad doctors.  They are probably sure of what specialty they will go in and think they have no incentive to learn anything outside of that specialty.  These will be the doctors that have malpractice issues later on.  I wonder how many 'medical mistakes' are actually made in medical school.

I realize that I too don't pay great attention in lecture.  Yet, I know exactly where I stand as a medical student.  I am the one that makes other students fill uncomfortable because I actually know the material we go over in histology and anatomy.  I am the student who asks the great questions during doctoring/interviewing patients.  I am also the student who studies much less than everyone else.  (I see it as if I learn a topic, then I will never have to study that topic.)  The difference has nothing to do with me being smarter than everyone else.  Memory is the lowest form of intelligence.  Even patients with severe mental retardation can memorize.  Animals can too.  

Perhaps they aren't that motivated.  It's hard for me not to stay motivated when somewhere walking around Los Angeles is a healthy middle aged man.  While I was in class, he was at work.  While I was in anatomy, he picked up his kids from school.  He is now buying some groceries before he heads back home.  He is going to watch television for the rest of today.  I am still deciding what to do for the rest of today.  One day, he won't be middle-aged.  He will be in a hospital.  When I go in to see him, he won't be wondering if on Sept. 2, 2008 I watched television the entire evening.  He won't be wondering how well I did in medical school.  He won't be asking if I was a marginal pass at a medical school with only a pass/fail grading system.  He won't be drilling me with questions to gauge my knowledge.  He won't be doing any of this......and he shouldn't.