Heart Failure - Preface

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

To all the students who went to bed crying
or woke up screaming.
To all those who needed to leave their hearts at the door.

Four-pointed star - "The four-pointed star... is a phenomenon carrying a grave and solemn warning."[1]

Besides medical school, there is probably no other four-year experience - unless it be four year's service in a war - that can so change the cognitive content of one's mind and the nature of one's relationships with others.
- F.D. Moorse, Harvard Medical School

This is the School of Babylon
And at its hand we learn
To walk into the furnaces
And whistle as we burn.
- Thomas Blackburn

I just graduated with honors from Tufts University School of Medicine, the class of 1999. I don't feel honorable, though. I have become disillusioned - disgusted even - by medical training and medicine as a whole. I want to help others dispel their illusions as well.

Medical school is four years long. The first two years are basic science lectures, more like an extension of college. The last two years, however, third year and fourth year, involve rotations through hospitals. "One of the few statements with which most physicians would agree," one doctor writes, "is that the third year, the year on the wards, is the critical year in medical education." [2] "In no year of their adult lives," another contends, "do students change so much as during the third year of medical school."[3] This is my story of third year, the worst year of my life.

For many students, who - like me - have had no prior clinical experience, third year is the first real contact with medicine, the first taste of what doctors really do, what doctors are really like. I saw medicine as a humanistic career of intimacy - helping people, sharing, caring for people. But what I found was a profession that didn't even seem to care about people. No one around me seemed to question what was happening to them, to the patients, to all of us. As Michelle Harrison wrote in her book A Woman in Residence, "I came to feel I had been fighting a war which no one else even knew existed."[4]

The unusual format of this book is a result of its origins. It started out as excerpts from my diary, a compilation of notes I scribbled to myself in the dark - fragmented snippets, flashes of images. Disjointed and chaotic, it is a reflection of my life and mind at the time.

The sharing of anecdotes can be emotionally powerful, but often cannot give a sense of perspective. For example, I witnessed doctors do terrible things to people. But was it just that doctor, that department - or was it most doctors, most hospitals? Finding myself so often in hospital libraries, I started searching out evidence that I was not alone, evidence that others had seen what I saw, felt what I now feel.

I discovered thousands of studies of medical education. There were whole journals dedicated to studying medical training. I extracted what I found to be most poignant and relevant from this vast literature and assembled these broader perspectives into appendices which I refer to throughout the book. I rely on these expert witnesses - prominent figures inside and outside of medicine - to supplement my personal experiences.

Why did I write it all down? Catharsis surely, a way to get medical school out of my system, but also as a way to not forget. Author and doctor Martin Shapiro wrote a similar book called Getting Doctored (in his words), "in response to a consuming anger that I felt towards the process of medical education." [5] Writing also helped me not be consumed.

Another reason was that I wanted to share, especially with premeds - those who are considering a career in medicine - a version of medical education that they will not find in medical school brochures. Steve Bergman, author of the reigning classic of the genre, The House of God, described in an interview a kindred motivation, "I just didn't want anyone else to have to go through that cruelty." [6]

As best-selling author/MD Robin Cook wrote, prefacing his The Year of the Intern, "This book is dedicated to the ideal of medicine we all held the year we entered medical school.... All the events described here are real."


ISBN 0-9678288-1-3
Anti-copyright 1999 Michael Greger
Please feel free to use in any (nonprofit) way.
185 South St. #6
Jamaica Plain, MA 02130
(857) 928-2778


[1] Koch, R. The Book of Signs New York: Dover Publications, Inc, 1955.

[2] Reilly, PR. To Do No Harm: A Journey Through Medical School Westport: Greenwood Publishing Group, Incorporated, 1987:104.

[3] Braverman, AS and B Anziska. "Challenges to Science and Authority in Contemporary Medical Education." Academic Questions 7(1994):11.

[4] Harrison, M. A Woman in Residence New York: Random House, 1982:233.

[5] Shapiro, M. Getting Doctored Santa Cruz, CA: New Society Publishers, 1987:9.

[6] Rovner, S. "Doctor with a Shot of Humor." Washington Post 22 March 1985:C1.



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