“You learn to ice skate in the summer and you learn to swim in the winter.”

One dichotomy that makes many fields particularly challenging is the dichotomy between the generalist and the expert…and the simple fact that you sort of need to be both¹. As a practicing physician, you should know something about everything and everything about something – that is, you need to know all the basics of human physiology, and then try to know basically everything about your particular clinical specialty. Even if you are destined to become a brilliant brain surgeon, you should still understand the gastrointestinal system, right?

I think medical students sometimes feel caught in the middle. It’s not always clear how detailed to get or how broad to let yourself go. For instance, in learning biochemical pathways, we don’t delve into all the structures and electron exchanging involved, so we are certainly not discussing nitty-gritty details². Neither, though, do we get waaaaay broad and tackle how the disease affects an individual’s livelihood, let alone the healthcare system. We are not biochemical experts, but we will also never be full-fledged comprehensive caregivers.

It’s silly and naïve to want to do everything…

…but it’s a difficult sentiment to avoid when you yearn to see how everything relates. In some ways, going to medical school after a liberal arts background feels like an incredible jump toward specialization, but in others respects I sense that many of us here still feel “too broad.” It’ll be a while yet before my cohort chooses clinical specialties, but you can begin to see people having fleeting fancies.

Of course, there is also the more general sense of the term “general” when applied to skills. You have to know who you’re working with, how to get through to people, and how the systems are fitting together. Know something about public health issues³ and epidemics; maybe even dip your toe in the political issues⁴ surrounding healthcare delivery. Maybe it’s actually good for doctors to be interested in this stuff...or maybe it just serves as a proxy for general intellectual curiosity. Maybe what we really care about most in our doctors (and teachers, friends, etc.) is that they want to keep learning and keep improving. There are a lot of intangible skills that don’t get tested, per se, before you move on to higher education. 

In theory, I like the idea of a well-rounded physician, but let’s face it: if the best heart surgeon in the world has no friends or family, I still want him to do my operation. When I seek medical care myself, I want a doctor who will listen, but also one who knows their stuff. No one’s people skills will make up for a depth of scientific knowledge (though they can certainly enhance it).

All of the things. I want to do ALL OF THE THINGS. 

Doctors are not always practicing medicine in the hospital, but also doing research, teaching, managing, consulting, etc. Earlier this spring, Charles Bosk, a medical sociologist, reminded me that “you learn to ice skate in the summer and you learn to swim in the winter.” He is a brilliant man, and our conversation wandered for quite some time; it left me feeling simultaneously excited and overwhelmed. We focused on issues related to career choices, but I thought later about how the same principles apply to our athletics, our relationships, and countless other things. A friend and I talked about how we want to run faster 10k races and also one day do a marathon, but no one can ever really excel at both since training faster and training longer are two different things (let alone the fact that this means we are setting aside swimming, dance, soccer, and our other previous endeavors). Likewise, with relationships, you sometimes have to choose between deepening the friendships you have and reaching out to new people. Trivial as it may be, it’s a little disconcerting that every minute we spend on one thing is one that we are not spending on another.

To a certain extent, it’s true that you approach problems in different ways if you’ve had experience in other realms. I worry, though, that when we spread ourselves too thin we end up mediocre in many things and really good at none of them. I probably spend too much energy thinking about these things and not enough energy making changes based on my reflections⁵. What do you think about breadth versus depth? Is that even a legitimate question?

¹ I’m fully aware that – technically speaking – it’s not a dichotomy if these categories can overlap. Let’s just go with it, because I really like the word “dichotomy.”

² I not-so-secretly miss college chalk boards and arrow-pushing in organic chemistry class, and I realized the reason I very secretly loved physical chemistry was that it was just all applied calculus.

³ In 5^th grade, we had to do a report on a societal issue; there were about ten reports called “Global Warming,” but mine was called “Meth Labs.” So that was fun.

⁴ [cue gasp here]

⁵ read: overly-analytical-and-generally-unproductive ruminations