I wonder if I will ever stop thinking of summer, specifically July, as the beginning of the medical year. For 10 intense years of my life, summer meant change:  new beginnings, new challenges, and increasing responsibilities.  Even though I’ve been out of practice for nearly 5 years, I still think about it as July approaches.

Summer marked the start of medical school, with July being when clinical rotations commenced in the third year and when the transition to the fourth year occurred. July was when internship began, followed by each new year of residency. Fellowships began later but still in the summer. 

Each year brought advancement and a new role commenced, finally culminating in graduation to being an attending. An independent practitioner. Free to practice medicine out in the real world.

With each advancement, I found myself thinking, “I’m not ready for this. And yet, I can’t imagine what would have prepared me further.” This makes me wonder, did I receive informed consent for medical education and training? Did you?

Informed consent is the formal process through which doctors obtain a patient’s permission to perform a medical intervention. It involves sharing information about probable diagnoses, possible treatments, alternatives, and complications. It requires that the person who will consent has the ability to understand the information, its implications, and potential outcomes of each choice, making a conscious decision willingly after having time to digest the information. 

In my case, coming from a non-medical family, I lacked a true understanding of what the lifestyle would really be like. It’s one thing to experience something for a few months, but it’s entirely different when it becomes a lifelong commitment, not just another temporary rotation. 

I gained some insight during training.  There were specialties that I quickly realized were not for me. However, in the excitement of pursuing orthopedics, I can’t say I really grasped the reality of what practice would be like. But I believed I had enough information, and made my decisions, even bending my results on quizzes designed to help me choose a residency specialty. Interestingly, those in the field encouraged me, while internal medicine residents discouraged me, due to the lifestyle demands of a surgical field. 

My point is that while there are many aspects about myself and the options that I did understand. There were others that I couldn’t discern or even accept fully. When you tell 20-year-olds that they will one day grow old, do they truly comprehend what that means? No. Of course not. The only way to genuinely understand is by experiencing it firsthand. Just like patients often don’t fully appreciate the implications and complexities of a medical diagnosis, treatment, or surgery. And since everyone’s experience is inherently unique, there is only one person who could have given me informed consent. Future me.

Only your future self could adequately consent you for what your experience would be. You can seek advice from the students and residents above you. Or the experts, the practicing physicians. Other people can tell you their experience but they can’t predict your particular journey. 

People differ in countless ways. Let’s consider just one factor that shapes medical life: sleep deprivation. Different individuals have varying requirements for sleep to function optimally. My grandfather slept only 4-5 hrs a night his entire life and had more energy than anyone I’ve known. On the other hand, I am at my best with seven. I manage with less temporarily, but if sustained, it negatively affects my cognitive abilities, not to mention emotional regulation.  

Aside from individual differences, acute sleep deprivation can trigger a seizure, while chronic sleep deprivation has been implicated in the development of multiple medical problems like weight gain, high blood pressure, coronary artery disease, kidney disease, diabetes, stroke, and dementia. I don’t recall learning about that in medical school (and to be fair, only some of this knowledge may not have been available at the time.)

Would you have wanted to receive consent from a medical student (i.e. your younger self), who had only read about the procedure and complications? Or the attending physician with 20 years of familiarity with the procedure and all its potential pitfalls? Instinctively, we understand that the attending would give better, more nuanced information, just like future you.

And even if a more informed consent had been possible at the time, would it have mattered? Would more information or experience have influenced your decision? 

During informed consent, patients often believe that the worst scenario can’t happen to them, and they underestimate the potential hardships and difficulties. Physicians are no exception in medical settings. In fact, some may even consider themselves more immune to the medical issues typically associated with "patients."  Due to frequently being in the position to administer pills, needles, scalpels, or IVs, physicians may become desensitized to the potential vulnerabilities they might face themselves.

This is true outside of the medical settings as well. We tend to over or underestimate both good and challenging outcomes as we anticipate the future of our lives.

The only option is to trust that you are making the best decision possible with the current information available and to course correct as needed. (Which also happens to be the best you can hope for from your own doctors.)

In my case, I don’t harbor any regrets about my decision to pursue orthopedics. It brought me great fulfillment throughout my career. Moreover, opting for an alternative path would have felt like setting for second best, choosing something within my comfort zone, rather than embracing the excitement and challenges that orthopedics offered.  

Ultimately, all you can do is have faith that you possess the best knowledge of yourself than anyone else could have at that moment. And give yourself kindness and grace for the decisions you made along the way.

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