After more than 3 years of medical school, I am strongly convinced that medical school is good training for sociopathy. If you’re a normal, empathetic person, you may graduate with sociopathic tendencies. If you’re a full-blown sociopath (i.e. you cannot emotionally relate to others, you lie and cheat without remorse, your goal justifies your means, you torture animals for fun, etc.), you may learn how to fit perfectly in society.
If you’re a sociopath, it makes sense to become a doctor. When you become a doctor, people will automatically trust you … since you are some kind of authority figure. If people trust you, you can more easily deceive them. Failing to become real authority figures, some sociopaths would even fake their credentials.
You’re probably asking how I would know. Maybe you think I am a sociopath. Well, I certainly am not. (Even if I was, would I admit it?)
But, lemme ease your mind with a personal story …
When I was around 9 years old, I watched a movie, Free Willy. Since the movie is already really, really old (which also makes me really, really old), I have no problems spoiling the plot. Heck, with the title, Free Willy, what do you think happens at the end?
The movie is about a whale, Willy, who has been captured by evil men. They were going to bring him to an amusement park and make lots of money. When big Willy was entangled in the net, he was powerless to do anything. So he cried.
My young self thought, “You can’t do that to Willy. That’s abuse!” It was at that moment that my heart broke and I teared. I wasn’t bawling like a baby, but one tiny tear flowed from the corner of my eye and onto my cheeks. I’m glad the room was dark so I could wipe my tear without being seen.
I am an empath. I can relate to others’ emotions — even if they’re literally animals.
Now, I find that my compassion and empathy for others have subsided greatly. You won’t see me shedding a tear for a captive Orca whale. Chances are … you will lose a bit of former self in medical school. That is why students who first start medical school are so full of excitement and hope for the good they can do for society. But by the end, their excitement and hope has been transformed into a primal need to thrive.
The desire to do good and to treat the sick has been replaced by the desire to become the best. That means you will do whatever you can to get the right grades, to get into the right residency, and to make the most money.
Why? Due to the perverse nature of medical training …
3 Ways Medical School Turns Your Heart into Ice
There are 3 main ways that medical school will suck the compassion and empathy out of you.
1. It enslaves you with debt.
When a medical student first begins school, she is full of dreams and wonder. She counts her blessings, because she is so fortunate that someone has selected her to be among the elite. But slowly by slowly, over the course of a few years, her dreams fade away to give room to reality. She can no longer afford to go abroad and give free medical care. She can no longer treat the homeless and uninsured. She has to pay back her school loans. (Because if she defaults, she can lose her medical license! All that hard work, time, and money go swirling down the drain.)
Reality means that she needs money. She wants to buy a house, settle down, raise a family, and pay off that burdensome loan. So all that talk about helping out the poor, giving medical care to the needy … that falls to the way side. She’ll do it another day. But another day never arrives.
2. It promotes memorization over compassion.
Science is essentially cold, hard facts. Thus, there is only one right answer. Never mind that the next research will be obsolete or refuted in 5 years. Never mind that the medical knowledge will change drastically in 10 years. All you need to do is focus on the present. Memorize, regurgitate, and repeat until you’re at the top of the class.
To get A’s in your first two years, it doesn’t pay to be kind. It doesn’t hurt, but it doesn’t pay. Instead, it is best to concentrate your efforts on memorizing everything. Know every minutiae and every trivia.
Will memorizing everything help you become a better doctor? No.
To get high scores on your licensing exams, it doesn’t pay to be empathetic. All you have to do is … know everything. Know every minutiae and every trivia.
Will knowing trivia help you become a better doctor? No.
But think about it this way …
Will kindness help you get into competitive residencies? No.
Will higher grades help you get into competitive residencies? Yes.
So now you know what you gotta focus on.
Doctors who excel in this type of environment are brilliant when it comes to retrieving stored information. They’re like a walking computer. But place them with a crying patient, and they’ll scurry out of the room.
I guess that is why doctors still need to be reminded that they’re treating patients, not textbook illnesses. You’ve most likely heard of the common saying, “Treat the patient, not the disease.” Now you know why that sentence is commonly used.
Well, sometimes, you just can’t teach an old dog a new trick.
3. It forces emotional detachment.
To be good at procedures and surgeries, you will need to distance yourself from your patients. Every time you make a cut with a scalpel, you cannot think of the pain. Same thing when you staple the patient’s scalp shut, giving a shot, do a shave biopsy, or whatnot. You cannot think about it from the patient’s point of view.
Or else you may not do good work. I still remember when I used a metal blade (lancet) to prick patients’ fingers for diabetes day. Every time I manually pricked their fingers, I just kept imagining the pain. So after pricking 5 patients, I stopped and let the nurse do it. Safe to say, I didn’t do a good job that day.
Emotional detachment is vital for doing procedures. But after a few years in a detached state, you may very well lose the ability to relate. Surgery and OB/GYN doctors didn’t get their negative reputation for nothing.
This case from my surgery rotation will show you what I mean …
It was early in the morning and the patients have been wheeled into the pre-operative room. I introduced myself to one of the patients, since I was gonna scrub into her case in an hour.
I asked her, “What surgery are you getting today?”
Removal of a sebaceous cyst on her back.
She was ashamed of her condition, because the cyst constantly released an unpleasant odor. She took showers 3 or 4 times a day, but the smell keeps on coming back.
I told her that I have seen and smelled worse things in the OR (which is true), so she should have nothing to be shamed about. I’m in the medical profession, so I do not expect everything to smell like roses.
She smiled at me and thanked me. I finished the pre-operative note and headed to the OR.
After 30 minutes, I scrubbed in with a certified, grade-A bitch of a resident. I don’t think any of the medical students liked her. Still, I was on my best behavior and tried to help out as much as I can.
The nurses wheeled in the patient. The anesthesiologist gave her local pain-killers, but did not induce her. Therefore, the patient was wide awake.
The resident was doing the cutting, while the attending was supervising. I was assisting however I can. Upon the first cut, cottage-cheese-like pus squirted out of the cyst and got onto the resident. She was all gowned up, so it’s not a problem. Things like this are expected to happen in surgeries.
The resident then said, “I hate removing sebaceous cysts the most. I hate the pus and the smell. It is even worse than resecting a poop-filled bowel.” This was loud enough for the patient to hear.
All I could think of at the moment is how the poor patient must have felt. She had absolute no control of her condition. And not only does she have to go through surgery, she has to go through it with the doctor’s bitching.
What patient, right? It’s just a sebaceous cyst.
How Medical School Teaches You to Fit in Without Giving a Damn
Medical school not only teaches you how to be cold-hearted. It also teaches you how to be charming. This way, you can blend into society, like a wolf covered in sheepskin.
The best way to teach you how to blend in is to force you to conform to societal standards. If you don’t, you fail. This is where rotations and the COMLEX 2-PE comes in …
I have written extensively about rotations here and here. Overall, the 3rd and 4th year on rotations are a huge waste of time when it comes to learning medicine. However, it is great for learning about deception. The hallmark of a skilled sociopath is deception. The better she is at it, the less likely she is to get caught.
Let me give you a real-life example of how future doctors can learn deception.
By the middle of the 3rd year, you should have a pretty good idea what specialty you want to go into. So one of the most common questions you’ll face is: What specialty are you going into?
There are the honest people. And then there are those who want to get on the good side of the doctor through whatever means possible. If the doctor is a surgeon, she’ll say surgery. If the doctor is a cardiologist, she’ll say cardiology. You get the drift. Basically, she is hoping to be liked by contorting herself to please whoever is in charge.
It is actually a very good tactic, one that is grounded in social psychology. You will generally like a similar person more. This describes racism, nationalism, ethnocentricity, and the way people interact.
It is dishonest, but it works. This is exactly what a smart sociopath would do — get you to like her.
That example is just the tip of the iceberg. I’m not gonna dig into it. You’ll learn about it during your rotations.
COMLEX 2-PE (or USMLE 2-CS)
In my opinion, Step 2-PE is totally unnecessary and totally stupid. Its main purpose is to enrich NBOME (the organization that runs the licensing exams) under the guise of training compassionate doctors.
The PE is good for training you to pretend you care. Since the standardized patients are all acting, they don’t really have the illnesses. Therefore, how could you really care for something that isn’t real?
But what you can do is show that you care, without actually caring at all. You learn how to be deceitful. The better you are at it, the better your score will be. (And the better sociopath you’ll be.)
If the “patient” is pretending to hack up a lung, you can gently touch her shoulder and ask if she could use a glass of water.
If the “patient” has a temper tantrum, treat her with kid gloves. In the exam, you say, “Oh ok, we’ll talk about this another day then when you’re feeling better.” But in real life, you would kick the patient out of your practice.
Not only is the PE good training for future doctors, it is also good for future politicians. Talk a good talk, but only walk the walk when it suits you. As long as you say it in a way that is convincing enough and politically correct enough, no one will think twice about your “good” intentions.
A Wolf Will Never Admit to Eating Sheep
Don’t expect doctors or medical students to corroborate what I say. Most won’t even realize what they’re learning. And if they do realize it, why would they spoil their sterling image and admit to it?
You’ll hear all the neatly-packaged and carefully-edited marketing stories: selfless volunteer services, heartfelt patient care, and pioneer research which paves new ways to better health.
“Deceitful? No, not me,” says the most cunning and ruthless sociopaths. “I went to medical school. And even took a course on professionalism.” As she shakes your hand and kisses you on the cheeks, she won’t hesitate to plunge a knife in your back. She’s already done it to countless others.
This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.