What I Wish I Knew Before Med School
I've found med school pretty demoralising.
These are some ideas that helped me make sense of things. Maybe they'll help you too.
1. Things are uncertain
In theory, problems are clean. Either your code runs, or it doesn't. Either your proof is valid, or it isn't. There's no ambiguity.
But in practice, it's the opposite. Nature deals in probability: emergent properties of unpredictable consequences of phenomena we don't yet understand. There's only ambiguity.
In medicine, there's no luxury of flawless top-down theories. Some things are more likely than others, but nothing is ever certain. So the decisive skill is learning to make a call despite this uncertainty, rather than looking for guarantees that don't exist.
2. Doctors absorb risk
Sometimes, the wrong call is made. Diagnoses are missed, and treatments fail, and people suffer. Even if everything's done by the book, things can still go wrong. Either way, somebody needs to be responsible.
When a doctor takes on a patient, they're putting skin in the game. They're taking on risk, despite the uncertainty, in an attempt to make things better. But of course, risks aren't free.
3. Study is endless
Unlimited uncertainty means unlimited preparation. Anybody can walk into a hospital, with any problem, at any time. Even if we pull hundred-hour weeks for the rest of our lives, things will still be missed.
At every step of the way, from medical school to postgrad exams to clinical practice, there's no way of knowing if we're ready. More preparation is obviously better than less, but eventually, we have to test ourselves against the real world.
4. Factor in politics
There are only so many patients. Medicine is learned by doing, and with finite opportunities, not everyone can learn everything.
To solve this problem, we created specialties. These are political boundaries, designed to divide up the pool of patients. Like everything in politics, they come with inefficiencies and overheads. But because specialising is a discrete threshold, it's either worth paying these costs readily, or not at all.
5. Be internally driven
Things are changing. As technology advances, politics become increasingly detached from reality. Soon, earnest work is ignored, and then discouraged, and then actively punished.
This doesn't mean we should blindly abandon the idea of specialising. But equally, if we rely on external (rather than internal) motivation, we'll be led increasingly astray over time.
The world is speeding up. Old incentive structures are breaking. Who are you, and what do you stand for?
Nov 2026