Saturday, January 17, 2009

On medical education at Columbia

Medical education at Columbia is intense right from the beginning. You come to Washington Heights and are immersed in a community that seems foreign and at times even hostile. Eventually you and the dental students get along just fine, but at the beginning they can seem strange.

Second year of medical school is memorable for a lecture they give on how they choose which patients get heart transplants. They put a number of cases up on a board. There's a nun, a child prodigy, an ambulance driver, and so forth. But the person who ends up winning is a British man who deposits $250,000 into a Columbia escrow account and flies over on his own jet. (I'm not making this up, by the way.) It's an amazing moment, since if you listen you can hear the number of your classmates who are planning to go into primary care plummeting.

Third year is something entirely different, though, because people who know you suddenly decide that you are a real doctor, and that they want to ask you a lot of embarrassing medical questions. And you decide that you want to hear those questions, and maybe even answer them. Usually your Hippocratic oath pulls you through, though, and you end up saying, "Look, you're the attending. Maybe you should decide what we're doing with this patient."

Fourth year of medical school is where you start to appreciate some of the things Columbia gives you that no other place does. Such as "Robbery Reports." Here's one from last summer:
Robbery Report — At 2:30 a.m. on Saturday, Aug. 13, a student was walking near the Health Sciences campus when she was approached by an organization calling itself the National Board of Medical Examiners. This organization demanded $1,000 for the student to beta-test its clinical skills exam, and did not even offer to grade it. The student became suspicious when she remembered that Columbia had charged her $500 to take the same test three months earlier.
If you can laugh at that, you laugh at the fact that the amount of money it now takes to send 150 people through four years of medical school is almost enough to buy a one-bedroom south of 140th Street.

And here you are today, ready to leave a life of taking constant unnecessary tests and to enter a new life of ordering constant unnecessary tests. You may wonder whether you have what it takes — whether you're really different than the person who got here four years ago. Is it just that your white coat is longer, or are you actually getting shorter? ...

Speaking for myself, I will do everything possible to avoid being hospitalized in the next six months.
--Josh Bazell, Columbia Med School '05-'06, during his Class Day 2005 speech

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