What advice could you give to a medical student in their first years to be a good doctor?

There are many. Hold on.

1 You have entered a medical college. Drop this entrance test preparation bullshit now. You have got 5 years before you do PG. That’s a hell lot of time. Ever wondered what you were 5 years back? A kid of 7th std. Ignore those DAMS preachers. They are not good for your health. MBBS is to attend clinics, observe patients and learn clinical skills. MCQs can be crammed anytime. One year of Marrow subscription during internship is enough to get you a decent PG rank. Don’t spoil your 5 years eating and vomiting MCQs all the time. Learn concepts dude.

2 Effect comes before cause. Every disease that has been encountered by medical professionals in their lifetime has presented with an effect. Symptoms and signs that is to say. Discovering its pathophysiology has been a later task every single time. We saw cough, fever, night sweats and weight loss and called it consumption disease(because of weight loss). Afterwards, people discovered the tuberculosis bacteria and labelled it a bacterial infection. Then we studied how the bacteria damages the tissues and got to know that its our immune system that really does the damage. Cytokines, immune cells blah blah blah…came later. I mean, of course they were present since the first case of TB in this world but they came to our attention much much later.

The point that I want to stress is, know the abnormal manifestations first and then study what abnormality happens at the molecular level. Trust me, a lot of your time will be wasted in doing the opposite and you will reach NOWHERE. Don’t read like a scientist. Medicine doesn’t work that way. Be a Sherlock.

3 Know the illness script. Illness script means the pattern of signs and symptoms that broadly describe a disease. It is what should come to your mind when you think of a particular illness. Aphorisms describe them well.

“If, in a fever, the neck be turned awry on a sudden, so that the sick can hardly swallow, and yet no tumour appear, it is mortal.” -Aphorism XXXV of Hippocrates.

This refers to the disease called Meningitis which is characterised by fever, headache and neck rigidity. ‘Tumour’ here refers to any general swelling. You see what I mean? Hippocrates first saw what manifestations the patient had and then modern science improved upon it. Such a pattern of symptoms when seen in a patient should strike MENINGITIS in the back of your mind.

A stroke is not a stroke until 50 of D50.

This means that a patient with stroke like symptoms should be first administered 50 ml of 50% dextrose before thinking of stroke because hypoglycemia can present like a stroke and giving dextrose reverses hypoglycemia. Thus, if the patient was hypoglycemic, he would improve and you could rule out stroke and vice-versa.

“Woe is the child who tastes salty from a kiss on the brow, for he is cursed, and soon must die.” – folk wisdom from medieval Europe

This refers to the disease called CYSTIC FIBROSIS in which salt cannot move as it normally does through the cells that line the sweat duct. Since sodium and chloride travel together as one molecule, the sodium/salt ends up excreted in the sweat. This makes for very salty sweat.

Apart from being an interesting memory tool, aphorisms also help you to realize how the medieval times perceived the disease and what aspects of that disease were the most prominent and bothered the people.

4 CLINICS, CLINICS, CLINICS. Attend them when you get in second year. Please. Keep that book aside and see patients. Everybody passes and everybody gets a PG seat. But not everyone has clinical skills. And that is the limiting factor in deciding who becomes a good doctor.

5 Don’t read word to word. Having studied NCERT, medicos continue their habit of reading word to word from mbbs books. A strict NO. You decide to read a chapter and as enthusiastic as you are, you even read the author details. Inch by inch you scan the pages but manage only four pages at the end of 2 hours. Tired as you are, you go to sleep. Next day, you don’t remember 90% of it. And since you had previously studied it with such detail, you won’t want to read it again. Here goes the effort in vain. You lose.

Instead, read layer by layer. First see what all is described in the chapter and what all you need to cover. You can see previous year questions to get an idea of what topics are important. Look at the headings and sub headings in which the chapter has been divided into. Next, see all the pictures and read their descriptions. All of this gives you a broad idea of what you are dealing with. Now, start reading the stuff in layers. Read like a newspaper first. Then give another read, this time deeper, focusing more on stuff that matters more.
Now, you will still forget most of it. BUT, you will read it again. BUT, from a different book. This way, your knowledge will expand because every book has some information that can be found in that book only. And, still better, the things which are same in all the books will be reinforced in your memory as you read them again and since you will not be reading from the same book, there will be no aversion to read the same topic again.
You can’t memorize whole of the medical literature. Even thinking it is insane. The book you read is written by an author who has super specialized in that field. Even his knowledge is limited to that aspect only and you have to cover a hell lot more things. You can’t expect to memorize everything.

6 MBBS is hard, you have to just study and forget all enjoyments. BULLSHIT! Medicine is learnt with enjoyment. Stress makes you suffer. Enjoy the journey. Don’t become a psychiatric case yourself. I repeat, everyone gets a PG seat with just one year of effort.

7 Don’t believe whatever your seniors say. Use your own head.

8 Ah! Cunningham’s. Please don’t buy it.

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