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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD

Do you have enough practical knowledge to be a good doctor?

Q: I am 14 years old and want to become a doctor. Not just any doctor, but a great one. How can I best prepare myself so I can excel one day?

Answer by , MD: In this site and especially in the question and answer pages in my site, I give numerous tips to help students become smarter, more creative, and more academically successful. In addition to following them, I recommend that you learn about many things besides science and medicine. I've heard several doctors say they can't do anything outside of work more complicated than screwing in a light bulb—as if that were a badge of honor! Such an admission is a testament to the fact that the doc uttering it does not possess the broad base of knowledge that it takes to become a superb doctor.

In their daily lives, patients are exposed to countless occupational, avocational, and residential chemicals (and other agents) that can cause or contribute to disease. Doctors who know medicine and little else often miss important diagnostic clues. Patients of those doctors frequently do not receive the correct diagnoses and treatment because the docs do not know enough to ask the right questions. Don't count on learning this information in medical school or residency, because the professors and attending physicians in those institutions are predominantly ones who are focused on medicine to the exclusion of other things.

Name virtually anything you can think of—shooting guns, reloading ammunition, mowing, welding, etching glass, carpentry, painting, electronics, working in a gas station, restaurant, or factory, and thousands of other things. Doctors should know enough about those and other activities so they can correctly diagnose their patients. In effect, doctors and the ones who teach them have deemed their requisite base of knowledge to be far more narrow than it should be.

Doctors often blow it even when the clue is found in one of the subjects taught in medical school, such as nutrition. For example, let's say that a middle-aged or elderly person who takes vitamins complains of joint pain. What's the first question that a doctor should ask that patient? Even when I give a huge clue by mentioning vitamins, most doctors reading this still wouldn't know enough to appropriately intervene. Consequently, this patient might endure many more years of pain. And that, unfortunately, is in something that should be right up the doc's alley. I'd wager that millions of people experience joint pain daily because their physicians don't know enough. Go further outside the province of medicine, and the situation is even gloomier.

To see how doctors can have such circumscribed knowledge, read White Coat: Becoming a Doctor at Harvard Medical School by Ellen Lerner Rothman, MD. In my review of that book on my site, I commented on her statement about a patient wearing "green Styrofoam hospital slippers." I was so struck by this that I took the time to actually make a Styrofoam slipper and test it. The test was, very predictably, quite short. It took just one step to fragment the slipper (see the before and after photos accompanying the book review).

Let's face it: patients do not wear Styrofoam slippers, and Styrofoam is hardly something so esoteric that a graduate of an exalted medical school should be ignorant of what it is. I don't mean to pick on Ellen too much, because she is hardly the first doctor who is the victim of leading an overly sheltered life. Many people seem to live in intellectual cocoons that stymie their acquisition of knowledge. Their learning is excessively limited to what is taught in their classrooms and textbooks, and their circle of friends is often restricted to clones who also never got their hands dirty. Despite the fact that they often can't see the nexus between joint pain and vitamin usage or even know the most basic facts about Styrofoam (not to mention the doctor-level Styrofoam info they should know), doctors with this limited base of knowledge often think they're hot stuff. I lampooned Ellen because I was amazed by how she seemed to be brilliant (must be, to get into Harvard, I reasoned), but also an alarming airhead. That's a strange mix, and if the folks at Harvard want to keep patting themselves on the back, convinced they have The Right Stuff, well, go on and keep deceiving yourselves. Your patients with joint pain, and those with other problems that you should have been able to solve, might not agree with you. (Article: The most commonly awarded grade at Harvard is an A.)

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One of the sheds I made (see more of them)

In my opinion, medical school Admissions Committee members focus too much on the egghead aspects of their applicants and focus too little on how broad their base of knowledge is. If someone doesn't enter medical school with a good foundation of that knowledge, when will he or she learn it? Certainly not in medical school or residency, when the focus is myopically on medicine. Talk about what might happen to a real patient once he unloads and begins using the stuff he just bought at Home Depot? Heavens no! That's not medicine, is it? You bet it is! To be a superb doctor, or even a good one, you must realize that the myriad environmental influences in the lives of your patients are not irrelevant. They can make the difference between living or dying, and happiness or pain. Irrelevant? Ha!

One of the sheds I designed and built
More pictures of it

Because this information is crucial, I think that medical schools should administer a standardized test of practical knowledge to ferret out folks like Ellen whose book-smarts seemingly exist in a vacuum of practical knowledge. In my other ER site, I flippantly termed it the MCAST (Medical College Airhead Screening Test). Think you'd pass such a test? Read the section of the interview that begins with the question, "What do you think admissions committee members should look for, besides the obvious, such as high grades and MCAT scores?" In it, I mentioned a real-life case in which an ER patient with a 13-inch glass tube up his rectum came perilously close to being cooked alive because the ER doc didn't have enough practical knowledge. This should be a no-brainer. In the years since I posted the challenge, a few people have submitted some decent guesses but no one has yet proposed the easiest and safest solution. If you figure it out, I might offer to let you help build my next shed, during which time I'll teach you a number of practical things. What a deal, right? :-)

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