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Mysteries of medicine: Why I’m not learning as much as I thought I would in medical school

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Before I began my first year of medical school, I imagined that learning diseases in medicine would follow a fairly well-defined, sensible format. First, we would learn about the normal physiology of the body – what is happening inside a healthy, normal body. Next, we would learn about exactly how the disease process disrupts this normal physiology and about the signs and symptoms that we can observe in a patient with the disease. Finally, we would learn about treatments that help the patient get better by targeting the underlying process that is disrupted in the disease.

Instead, as one of my colleagues eloquently noted in this very blog, I’ve quickly learned that many conditions in medicine are nothing more than labels. We observe a collection of symptoms, give it a name, and may or may not stumble across the underlying cause or any (if we’re lucky) effective treatments.

I used to think that this kind of empirical, trial-and-error approach was an outdated relic of the past. In the Victorian era, syrups given to calm fussy babies contained large concentrations of morphine – presumably before it was known to be a potentially dangerous and addictive narcotic. For many years, lobotomies were routinely used for the treatment of neurologic and psychiatric conditions, before we had knowledge of the critical importance of the parts of the brain that were being removed. Surgical procedures used to be performed with bare, unwashed hands, before we understood the concepts of infection and transmissible disease.

As easy as it is to look back on prior eras and marvel at how little they seemed to understand about certain drugs, diseases, or treatments, medical school has taught me that we can easily say the same thing about ourselves, here in the year 2015. The way that acetaminophen (Tylenol) relieves pain is still not well understood, despite the fact that millions of people take it every day. Similarly, electroconvulsive or “shock” therapy sounds like it should be outdated, but in fact remains one of the more effective treatments for severe depression. The causes behind an entire field of autoimmune diseases remain mysterious in most cases.

Because of this, I can’t help but wonder what medical students one hundred years from now will say about us when they look back at our era of “modern” medicine. I have no doubt that they will talk in amazement about some of the things we do. In the meantime, I’ve been learning to accept that being a doctor will require us to simply suspend our disbelief from time to time and admit that, every once in a while, we will need to do things for no better reason than because – for some reason – it works.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

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