As A Doctor, Is There Anything You Learned In Medical School That You Now Disagree With?

This question was originally posted on Quora.com and was answered by Robert Frantz, B.S., M.D. Zoology & Medicine and Healthcare, The University of Oklahoma (1996)



In my medical school, we started with what would be the equivalent of about 27 credit hours of undergraduate coursework. Semester two was north of 30. It got way worse from there. If you were to go and talk to your advisor, the general advice you got was “work harder”. Like, “Dr. Smith, I’m feeling a little overwhelmed.” “Work harder.”. “ Dr. Smith, I’m afraid I’m going to flunk anatomy”. “Did you try working harder?” “Dr. Smith, I’m super depressed and I’ve been unable to concentrate and lately I’ve been thinking about either dropping out or killing myself.” “Clearly, you aren’t working harder. You need to work harder.”

By the time we arrived in residency we were all socialized to shut up and work harder. That was super handy, because now Dr. Smith was super all over your ass and so were his buddies because now you were actually getting paid something like $2.30 per hour. You really didn’t have any excuse for not working harder now that you were being so luxuriously paid and what not.

By the time you get out of residency you are so brainwashed you practically have Stockholm Syndrome. You have spent at least a decade of your life and probably more getting here. You are expert in delayed gratification and your coping skills consist mainly of “working harder.”

Now, male physicians are 1.4 times more likely than their peers to commit suicide. Female physicians are over twice as likely to commit suicide. Doctors are not encouraged to talk about their issues. Burnout is rampant. As Dr. Windham has pointed out, our training is a large part of the problem. They were wrong.

This question was also answered by Jonathan Geach, MD Doctor of Medicine, Loma Linda University School of Medicine


On my first day of medical school, the Vice Dean of Academic Affairs Dr. Leonard Werner MD walked into the lecture hall.



He was an excellent teacher. His pathophysiology class was lengendary and I still remember it to this day.



He carried an old large brown book with him. He said,

This is an old textbook of internal medicine. It was my grandfathers textbook in medical school and to me is a priceless heirloom. I’m sure you are wondering how much of what is in this book is correct. The answer is half.

Now here is your copy of Harrison’s Textbook of Internal medicine. Do you know what? About half of this book is wrong too. I just don’t know which half so you have to learn the whole thing.

This is why doctors read studies. This is why we have to weigh the validity of a study.

When I was in medical school I was taught that opioids like morphine, Dilaudid and Fentanyl are not very addictive. I was taught that there is no ceiling on narcotic use and the chance for addiction in otherwise healthy people was very low.

This knowledge was the seed of the opioid crisis facing America today.

Almost all this information is false. Opioids are very addictive and ruin lives. I am so glad I did a fellowship in pain medicine to learn about the appropriate use of narcotics and ways to treat pain without them.


This question was also answered by Mark Roseman, Biochemistry Professor at Uniformed Services University of the Health Sciences (1979-present)

As you can see from the answers by MDs, one cliche is that half of what you learn in medical school is wrong. Another interesting statistic is that the half-life of medical knowledge is 10 years.

These numbers do not pertain to basic science, such as gross anatomy. The leg bone is still connected to the ankle bone. In biochemistry, energy still comes from the oxidation of food. Proteins are still made from amino acids. DNA is alive and well. Cancer is still caused by mutations.

I know enough about the clinical side to say these statements about facts as fleeting are incredibly misleading. The flaw is they treat all facts as equally important, which they are not.

Diabetes is a good example. The signs, symptoms, and basic pathophysiology of the disease has been understood since I started teaching in 1980. If these facts have not changed since 1980, they are unlikely to change in the next ten years.

What is sure to change is our understanding of the details in Type 2 diabetes. How does insulin resistance begin? Why are some people more susceptible than others? Why does obesity seem to increase the risk? Why does insulin resistance increase with age? What is the best diet? Why does exercise seem to help? What are the best treatment strategies?

Think of knowledge as a tree. The basic problem in diabetes results from lack of insulin (Type I) or failure of insulin to exert its full effect (Type II). This is the trunk of the tree. It will not change. The main limbs represent dysregulation of the pathways that require insulin, including carbohydrate, fat, and protein metabolism. This will not change. A big branch off the carbohydrate limb describes the effect of hyperglycemia on water and electrolyte balance. This will not change. Another branch describes the effect of glycation on body proteins. This will not change. A branch off the lipid limb describes ketoacidosis (for Type I) and hypertriglyceridemia. This will not change. A branch off the protein limb describes muscle wasting (Type I). This will not change.

The goal of research is to understand these observations in detail. This is where the tree forms branches leading to more branches, leading to more branches and becomes a huge thing. Way out at the edge, the tree is full of leaves, thousands and thousands of leaves. These are like recent research articles. Here is where the majority of change takes place. This is where the tree needs to be pruned every so often.

A similar tree could be constructed for heart disease. Heart attacks are caused by a blockage of blood flow in coronary arteries, owing to a build up of plaque. That will not change. What will change is understanding the details of plaque formation and how to prevent it.

Medical students have a way of taking all facts and turning them into flashcards, and I suppose doctors do the same thing. Everything becomes a list to memorize. Suppose these two facts are taught about heart disease.

1. Heart attacks are caused by a buildup of plaque in coronary arteries.
2. Eating eggs causes a buildup of plaque in arteries.

So a new study comes out that reverses the advice about eggs. Medical student conclusion: half of what we learned was wrong.

That cliche, “Half the facts you learned in medical school are wrong; we just don’t know which ones,” is amusing but not true. You do know which ones are unlikely to change: the ones that have not changed in the past 40 years.

(There are exceptions. The one about eggs may be one of them.)

The cliche should be modified to: “Half the facts we care about will change.”

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