There are only two more exams before winter break. At 11:59PM this coming Sunday (at the latest), I will be finished with 1.5 years of medical school. First up is the pharmacology exam, which I will have to take by Thursday night at the latest, and last is our Brain and Behavior exam, which closes on Sunday at the aforementioned time. Overall, this semester has been similar to last year in several ways, mainly relating to my ineffectual study habits, horrible work ethic, and inability to engage with or grasp the material being taught to us (which I reiterate for the 14th time, John!). It's a shame, because it's only when exams roll around that I start to appreciate how interesting (sort of) and important (sometimes) our classes are.Take pharmacology, for example. All of medicine revolves around this course, and any medical research of consequence involves the eventual application and utilization of this important field. But one thing I am finally starting to learn for myself is how imperfect of a science medicine is (as opposed to reading about this same concern in books written by Atul Gawande). This upcoming exam will test us on the various mechanisms, properties, and adverse effects of over 150 different drugs. I don't think I'm even halfway through them yet, but I can already see a pattern. For many drugs that have proven effective in treating a disease, the biggest problems lie in the host of adverse side effects the patient will have to endure. You can prescribe clozapine to treat schizophrenia, but along with that you'll have to prescribe a variety of other medications to deal with the resulting metabolic syndrome and other symptoms caused by the blockade of various receptors by clozapine (muscarinic, histamine, alpha-1, etc.).
In the end, it seems like pharmacology, and to expand upon that, medical treatment as a whole, is often just a giant crapshoot. Doctors do their best to be scientific, "evidence-based," and logical with the whole process, but the underlying principle is basically trial and error. See what works, the best combination of drugs and procedures, and do your best to mimic that in a real-life setting. Half the time, the exact reason a medication works is unknown, and it is then characterized with the fluffy label, "disease-modifying." But I guess it's difficult to expect any more of medicine than this. There have clearly been centuries of teaching and research that have gone into establishing this institution which, for the most part, works miracles every day.
Problems arise because most people, physicians included, fail to acknowledge these important limitations of medicine. Science can only take you so far - and doctors who invest their entire beings in a broken system will eventually end up disappointed. When I was writing my various personal statements for both undergrad and medical school, I often described medicine as "my calling." But my mindset has changed since then. I want medicine to describe what I do... not who I am. Which leaves that last, ages-old, fundamental question:
Who am I?
