“When am I ever going to use this?” was a common chorus at my high school, particularly in my math class, and especially as the algebra got more theoretical, multivariate, and moved toward calculus.
I can only assume that it remains a popular question in high school math classes today, owing to a certain seductiveness. It suddenly relieves the brain from the grinding gears of trying to comprehend complex equations and allows it to join in on a miniature populist uprising with the brains of fellow students: “Hey, yeah, when am I ever going to use this?” I do not envy the teachers who have to try to quell the revolt. But I assume they do so by explaining that, maybe, there’s a certain structure that builds in the brain when learning theoretical math, what with all that gear grinding, and this structure helps us in our thinking about many things throughout our lives beyond math.
Now, I want to take on a similar role as the aggrieved high school math teacher and reflect on a sentiment I’ve observed, both online and in person, relating to whether eventual medical specialists or surgeons are really ever going to use all that biochemistry, molecular genetics, physiology, and obscure pathophysiology knowledge. Learning all of this content has become a tradition for the first two years of medical training in the U.S., but there seems to be an uprising brewing: “How many cases of Alport syndrome is a medical student dead set on surgery going to manage? Why does she need to know that its inheritance is X-linked? I mean, come on, do we really need to learn all those minutiae? And while we’re at it, does medical training really need two full years of didactics before getting to the clinical aspects of medicine? After all, isn’t clinical medicine and patient care really what we’re here to learn?”
On the one hand, I understand the overwhelmed modern day medical student, who must have to learn ever more medical science (assumedly because the field is accumulating ever more studies). Moreover, certain professors in higher learning may have a bit of Pygmalion in them, wherein they’ve fallen so in love with their own research that they will wax poetic about rather minute details for hours — precious hours that the student could be using to drink from a high-yield fire hose of medical facts.
And yet, whatever our modern frustrations may be, I am compelled to defend the didactic years of medical school. I am even compelled to say that aspiring surgeons need to learn that Alport syndrome shows X-linked inheritance. Why? It’s not because I think surgeons need to advise their many Alport patients on what to expect when they’re expecting. It’s because these minutiae are part of a structure we build in our brains during medical school. And the structures we build inside our brains are lasting, even when the details become fuzzy. The minutiae are the fruiting parts of a garden, let’s say, and the garden is an understanding of human pathophysiology, of human disease. You plant this garden, you tend to it, you cultivate it, and then you move into the clinical years of medical school. In the future, you can use that garden for whatever you want. You can dedicate the whole garden to pathologic fractures and the physiology of bone healing; that fruit can get so sweet when you focus all of your gardening efforts on it, I’m sure. (I do apologize to the reader and my orthopedic surgery friends for this over-extended analogy.)
The point is, as doctors, we need to approach the clinical aspects of medicine carefully; we carry a great responsibility. And the purpose of medical school is not to learn how to perform the motions of doctors. It is to learn the profound art of medicine. This takes significant investment into building structures in our brains. Once we have the structures there, e.g., a foundational understanding of the nature of human pathophysiology, then maybe, just maybe, we will be prepared for that greatest test in medicine, should it come: seeing a patient with a truly unknown illness — perhaps due to atypical presentation only to be revealed post-mortem, or perhaps due to a truly novel disease process. As we’ve seen with COVID-19, the world still turns to doctors for problems outside the defined, algorithmic boundaries, outside of charted territory. And here there be monsters. We must be ready.
Andrew van der Vaart is an intern/resident in psychiatry.
