What Medical School Won’t Teach You

Medical schools serve to produce scientifically educated and clinically skilled physicians who understand human anatomy and can provide sound patient care. And while you are certified as an accomplished medical professional by the time you qualify, you might be taken aback by what the years in medical school didn’t teach you.

1. Emotional Skills

Most people decide to study medicine because they inherently have an empathetic nature and want to help others. However, medical training teaches them to understand what is happening to a patient’s body, but not what it’s like to go through what they are going through. On an emotional level, the training falls short. Medical training teaches diagnosis and treatment, but not how to give comfort.

Medical students get plenty of opportunities to talk to patients about their conditions and treatments, but not how to navigate complex family dynamics, diversity issues, or how best to approach grieving, angry, or uncommunicative patients and family members.

2. Financial Literacy

Financial stability is not easy for doctors to achieve because they start out at a tremendous disadvantage – a career that starts late and mountains of student debt. This burden requires financial acumen to handle efficiently, and medical school doesn’t teach that.

Financial literacy is not always high on the agenda of medical students, residents, and some attending physicians. Yet, it is a crucial aspect of life, which, if not mastered adequately, can have a serious impact on many parts of a physician’s life.

It’s not uncommon for physicians to lack financial skills, such as budgeting, saving, and investing. In all fairness though, very few people leave school or college knowing how to handle their finances.  

Medical schools are sending highly-trained professionals into the workforce who have no financial preparation for what it takes to run a medical practice successfully. Adding to this burden is the fact that new doctors are unprepared for the costs they will encounter to maintain their professional development, including exams fees, certifications, memberships, insurance, and more. 

3. Anything Business Wise

Highly skilled physicians can leave medical school without knowing how to startup and manage their own practice. While it’s true that most doctors are employed by large institutions, many plan to go into private practice. Running a practice, managing the financial and staffing aspects require business skills.

Physicians in private practice need to know the ins and outs of employing people, billing and coding, negotiating reimbursements, dealing with providers, and much more. Even doctors working in hospitals would benefit from understanding how hospitals operate as a business. The more they understand what makes a hospital succeed, the better they’ll be able to work with administrators to provide the optimal service.

There are several ways that any medical student can educate themselves on business. They can start with the book, Entrepreneur Rx, then listen to podcasts, or even take some basic courses to gain business knowledge.

4. Basics of Nutritional Science

This gap in the education of medical doctors is proving to affect the profession negatively as general awareness of the importance of good nutrition for health has grown among the general population, and they are demanding information on nutrition, supplements, and alternative treatments that doctors can’t provide. This may account for the trend among qualified medical doctors to seek additional training as homeopaths and naturopaths in order to treat the illnesses they are confronted with in their practices.

Medical students currently learn very little about the way nutrition and lifestyle affect health – and they should be taught more. Yet, most of the conditions that patients suffer from are a result of lifestyle and dietary habits. Prime among these are obesity, type 2 diabetes, anxiety and depression.

Medical schools are not teaching physicians to deal with so-called non-communicable diseases. Yet, these diseases are overwhelming healthcare systems across the world, so they no longer can be ignored in medical school training.

5. Health Care Policy

It’s common knowledge that the American health care system is in a bad shape. Yet, many physicians leave medical school with little understanding of how the health care system works. A course in health care policy could enlighten students about:

• The difference between Medicare and Medicaid 
• The different types of managed care 
• Private vs. public insurance 
• Drug legislation 
• Entitlement programs 
• When certain procedures are covered 
• Medical malpractice

Such a course will thus prepare them for the reality that, in the course of their work, they may be required to weigh the interests of the patient against the interests of the health care system.

Some prominent schools have started teaching courses on health care policy, but students are not electing to attend them because of their study load. 

This knowledge is necessary and would be practical for qualifying doctors. The fact that doctors are not trained in health care policy means few of them get involved in it, which is contributing to the current poor state of the health care system. 

In order to get doctors involved in fixing the system and stopping the surge of health care costs, medical schools need to offer health policy classes and make them compulsory. 

6. Burnout or Moral Injury

While the debate on whether medical professionals suffer from burnout or moral injury, medical school doesn’t not equip medical students to handle either.

Burnout in the medical profession is all too common. In 2020, 42% of physicians reported that they suffer from burnout and 50% of physicians experience at least one sign of burnout. 

Burnout is defined as long-term, unresolvable job-related stress that leads to exhaustion, cynicism, feelings of detachment toward job responsibilities, and a lack of a sense of personal accomplishment. Medicine as a profession also has one of the highest risks for suicide, with roughly one physician per day dying in this way in the U.S.

In recent years, many people lean more towards physicians experiencing moral injury, not burnout. 

Preparing students for the realities of practicing medicine and the toll it is likely to take on their mental health is an issue that medical schools are not addressing. Rather, the system is set up to generate burnout and mental collapse.

Physicians should be taught to recognize the early signs of mental distress and what steps to take to prevent it from escalating. It’s vital for residents and physicians to cultivate a life outside of medicine that prioritizes strong family and friendship connections, leisure activities, and outside interests.

7. Realities Patients Face

Medical school teaches students about the best treatment for each condition. However, students may seldom be able to offer the optimal treatment simply because patients can’t afford it. Medical school is far removed from the realities of the American healthcare system. Physicians don’t learn how insurance works and what treatments and medications actually cost, so they offer plans that people can’t afford. For most people, the cost, not whether the treatment will really help, is the deciding factor. Medical school doesn’t prepare you for this reality. Oftentimes you simply won’t be able to provide the best service or treatment that you know will work. 

Medical training doesn’t prepare you for the trade-offs you’ll have to consider. For instance, when a drug or treatment may extend a person’s life for a few months but is very expensive. What choice do you make? 

This may be why so many doctors end up feeling that they are not making a meaningful contribution, that they are not really helping their patients, which is a contributing factor to burnout.

8. Practicing Scientific-Based Medicine

This is shocking and not something a starry-eyed medical student wants to hear. It certainly isn’t inspiring, but it’s true.

According to research by Scientific American, only a fraction of what physicians do is based on solid evidence from Grade-A randomized, controlled trials. Most of what they practice is based on weak or no evidence and on their own subjective judgment. More dishearteningly, those physicians that do follow evidence-based treatment suggestions, often don’t follow them correctly. Only about 20 % of clinical-care practices are backed by solid randomized, controlled trial evidence.

Medical decisions are more often than not subjective, with even the most experienced physicians making diagnostic mistakes. This subjectivity, combined with the relative lack of solid scientific backing, often leads to wrong medical decisions.

In addition, and seemingly contradictory to the previous point, there is an explosion of scientific research papers, although not all randomized, controlled trials. According to one estimate, an internist physician would have to read 20 journal articles every day of the year to keep up with new findings. It’s simply impossible.

Final thoughts

The entire healthcare system, including medical training, is at a crossroads. There are too many aspects of what it takes to become a doctor and practice as one that are not covered in training. Also, factors that undermine the ability of doctors to provide the care they know they should and can give are not being addressed. 

The fact that an estimated 300 physicians die by suicide in the U.S. every year should be a clear indication that all is not well with the profession. It is important for medical schools to help train future physicians in moral injury/burnout to give them the tools necessary to be successful.