Review - What I Learned in Medical School
Personal Stories of Young Doctors
by Kevin M. Takakuwa, Nick Rubashkin, and Karen E. Herzig
University of California Press, 2003
Review by Duncan Double
Dec 28th 2004 (Volume 8, Issue 53)

This book starts with an interesting question - what happens to students in medical school? The first editor of the book seems to have had a particularly difficult time. He had to retake several examinations. His life was badly affected. He gave up his apartment and lived in his pickup truck, supplemented by some time in the reading room of the library, call rooms at various hospitals, and rooms offered by acquaintances if they discovered his plight. He did eventually graduate.

Submissions for this book were requested through representatives of the American Medical Student Association. Despite the restrictive nature of medical school, the editors have managed to collect a diverse set of stories of people from various backgrounds. The book contains congenial, unexacting narratives, showcasing students who come from other than the perspective of the white, wealthy, able-bodied, heterosexual male.

Personally I was looking for more from this book when I read the title. The introduction starts with the claim that many students in retrospect say that medical school was awful. I am not so sure that this is the case. The introductory chapter goes further to suggest that medical school is a process of indoctrination, stripping students of their individuality, turning out physicians devoid of personality, emotion and creativity. This sounds like a serious matter worth considering. The chapter suggests this process is due to being overloaded with work, which is dominated by rote‑memorization, avoiding in-depth study of larger questions. I think this is part of the problem, but not the whole story.

Having raised these major issues, the book then documents what it sees as the struggles of individuals against a powerful institution. By focusing on the stories of women, underrepresented minorities and people with disabilities, it suggests it is chronicling ways in which medicine's new demographic diversity is changing the profession. You may enjoy this book if these human features are all you are looking for.

Despite this agreeable aspect, my main feeling was of disappointment. I did not find too much description of what actually happens in medical school, rather than in students' personal lives. Nor did I find any analysis of the 'process of indoctrination', if indeed that is the best way to describe it. Although increasing diversity may change attitudes, it would surely be naïve to suggest that this alone will lead to change in power structures supported by dominant ideologies in medicine. Over recent years, medical education has taken a more patient-centered approach. Where is the critique of the barriers to this process?

I am glad if the editors managed to deal with their own sense of personal damage through writing this book. With more experience they may be able to write a critical account of the reforms required in medical education. For the moment, be content with an account of personal stories of people who perhaps should be the next generation of medical leaders, but probably will not.

© 2004 Duncan Double

Duncan Double, Consultant Psychiatrist and Honorary Senior Lecturer, Norfolk Mental Health Care Trust and University of East Anglia, UK; Website Editor, Critical Psychiatry Network.