Becoming a Doctor: A Journey of Initiation in Medical School

by Melvin Konner

"A valuable contribution to the growing literature of medical culture."—Gerald Weissman, New York Univ. Medical Center.

Genres: Medical, Medicine, Memoir, Nonfiction, Biography, Science, Health

416 pages, Paperback

First published January 1, 1987

About the author

Melvin Konner, M.D. is the Samuel Candler Dobbs Professor in the Department of Anthropology and the Program in Neuroscience and Behavioral Biology at Emory University. He is the author of Women After All, Becoming a Doctor and Medicine at the Crossroads, among other books.

Reviews

[Kathleen · Rating 2 out of 5]

A detailed account of medical school clerkships 30+ years ago, but mostly an ego trip for the author. No one is smarter or cares more for the patients, and by goodness, all the women patients are so blonde, petite, and sexual!

His relations with females are problematic. Ninety-five percent of women have descriptions regarding their physical attractiveness to him, and often have some description of their clothing as well if he deems it "sexual." It gets really uncomfortable when he starts describing a "very mature looking" 15 year old, that he really hopes he gets to do a physical exam on(read, unclothed). The men get no equivalent description. The reader has no idea what they look like except maybe one had a mustache. Also, ladies, he totally understands what childbirth is like because once he had diarrhea.

He did not have the best peer-to-peer experiences on the wards, but my armchair analysis is that his arrogance (he was a tenured professor at Harvard prior to med school) shone through and people didn't want to deal with that. For example, he tries to pull rank on a nurse because he has a Ph.D. in anthropology. In the classic Bulwer-Lytton mode, there is a lot of telling the reader how smart and compassionate he is, but very little showing. He may have had good rapport with patients (med students often do because they have more time than those higher up in the responsibility chain), but there is overwhelming evidence he does not know how to relate to people as equals or superiors, and he quickly dismisses opinions of those with more experience because he thinks he knows better. The closest he gets to perhaps acknowledging his arrogance is the false humility of hiding where he attended as "Flexner School of Medicine" and "Galen Memorial Hospital," simply listing both as among the most prestigious in the world. It would have been much less pretentious to just admit he went to Harvard.

More evidence of medical school just being an ego trip is that he never applied for residency, and therefore did not go on to practice, despite all his claims of wanting to go into medicine "to help people." This was probably a good thing however, since at the end he was thinking about possibly going into OB/GYN. Giving birth is just like diarrhea! And you get to see naked women!

Despite all the issues of an unreliable narrator, it is interesting to see how much medicine and medical education has changed and how much they have stayed the same, especially with more women in the field, more technology (a bad thing in his opinion), and a bigger focus on humanism (a good thing in his opinion, but a stopped clock is right twice a day, no?)

[Jason · Rating 5 out of 5]

Excellent. Really excellent. Its a great narrative account of a 31 year-old guy's four years in Medical School. The book is in parts gruesome, haunting, sublime, funny, and empathic. Its just a great book and better than a lot of ficiton I've read recently.

It goes year-by-year and specialty-by-specialty. So one chapter he's delivering babies, another he's watching a horrifying(for most people) labotomy, another he's dealing with an abusive, vulgar resident on the emergency ward, or his tragic experiences in the psychiatric ward. Good stuff.

One thing I like a lot is how he ends chapters. Sometimes he's very stressed out and he just describes a very funny instructor or really amazing patient experience.

Lastly, I loved how in the end he began putting medicine a larger context, besides heroic medical procedure. He brings together arguments he's been making slowly throughout the entire book about the flaws of authoritarian hospital administrations, the general derision for psychiatry or any practice non-specifically biological, or how a career in public health could reduce the amount of future illness doctors would even need to treat.

Also, the end of the book contains a reference to "medical house officer slang" which is fascinating. Codes like D.N.R. (do not resuscitate) or B.F.I. (big fuckin' infarct - big heart attack) and terms like "crispy critters" (kid burn victims) or "baby catcher" (an obstetrician), or GOMER (Get Out of My Emergency Room - an old person that keeps coming back with no real illness).

Basically, the slang is a form of efficient short hand, but also doctors probably just need to laugh at really bleak things, to deal with them sometimes.

[Amanda · Rating 3 out of 5]

Not a must-read, but a good one for med students. I actually read it once in college because I was an anthro major (the author was an anthro phd before he became a doctor) and was thinking about applying to med school. It was interesting to read it again nearly ten years later and in the throes of my MS3 year myself, the year book chronicles. I found it to be particularly interesting with regard to what it's like to go from being an adult with a career and your own self-sufficient life to being a student again, feeling and being treated like a child, and trying to figure out how to navigate the hierarchy of medicine. Konner has a lot of great insights into how we can be more human as doctors and connect with our patients as people, but he's a little self-righteous at times and even admits toward the end to developing some cynicism himself. ALSO I dunno if this is just a sign of the early 80s when this book was written but jeezus he constantly refers to women in the book--from patients to patients loved ones to his fellow medical professionals--in pretty sexual language, which was distracting and cringe-worthy at times.

[Coralie · Rating 3 out of 5]

This book had its good points and its bad points. I agree with other reviewers who thought that Konner was pompous and had a high opinion of himself. I did think that his descriptions of his medical school experience were insightful. He despised the arrogant doctors but really did seem to appreciate the ones who went out of their way to help patients and medical students. I didn't buy into the whole "I am more ethical than thou" premise. How ethical is it to become an absentee husband and father while you go to medical school on a whim?

[Z j · Rating 3 out of 5]

I started this book while waiting for the plane to Guatemala for spring break.
It's a more exciting read when you're waiting for planes and buses.






Anesthesiology, IM (GI or pulm), or EM

[KC · Rating 2 out of 5]

I am a little over halfway through with this book - just finished the pediatrics section. He does have some interesting things to say about medical education, but then again, what isn't interesting about medical education to anyone invested in health care?

The most disturbing aspect of the book is Konner's misogynistic outlook and outright sexism towards the girls and women he encounters throughout his journey. He expresses little repulsion for the surgeons' terrible attitudes towards women, and never chooses to defend his female colleagues, focusing instead on the bruises to his own ego.

In the pediatrics section he describes being so engrossed with an an attractive 15 year old girl that he couldn't stop thinking about her all day and was unable to perform a suitable exam on her, describing that using a stethoscope on her "seemeed like the most outrageouus act of sexual exploitation." I find it curious that at this time Konner had his own daughter; one might wonder how he would react to her being objectified and written about in such a manner. Conveniently, he chooses to describe this girl as a "woman" while he describes all pediatric male patients, even an 18 year-old, as "boys." Later in the pediatrics section he describes a 23 year-old woman who brings her young sister in for a checkup as "clearly sexual, with bright blue eyes, slightly curly, shoulder-length blond hair, tight black jeans, and a soft wool sweater pulled over large breasts." Are you kidding me? "Clearly sexual" to Konner sounds like any woman who happened to be attractive and sent his hormones into an uncontrollable tizzy. Add that to the fact that he never talks about how his wife or kids feel about the experience, never describes them (indeed it was so much more important to include his sexual inclinations towards a girl), and you begin to wonder about this self-proclaimed humanist.

If Konner describes the anorexics he evaluates as unwilling to "grow up," if he continuously complains about doctors' inability to connect to the humanity in their patients, then likewise he is guilty of being incapable of putting away (or at the very least evaluating the extremity of) his raging hormones which reflect that of an oversexed teenager, in order to focus on the confusion, pain, and suffering of his patients. He realizes that he is in a position of power as a medical student, that his patients and those who care about them come to him in a vulnerable state. He writes scathingly about doctors who violate the trust inherent in that relationship. Yet he chooses to sexually objectify female patients in his book, showing a profound disrespect and lack of concern for their human dignity.

It is completely understandable to be stunned by the beauty or handsomeness of any individual, but to become obsessive and hypersexual, to the point of being an incapable physician (or medical student), particularly towards a 15 year old girl, is not just inappropriate, but shows a fundamental lack of humanity towards the (presumably when attractive) opposite sex. I am ever so thankful this man did not have the fortitude and imagination of someone like Paul Farmer and chose not to become a doctor. Just watch out if you're taking his anthropology class anytime soon, he might be writing about your breasts next.

[Kristin · Rating 5 out of 5]

Unlike many books written about a doctor's medical training, this one focused solely on Konner's clinical rotations, leaving out the first two years of classroom learning. I've read many books where the first year gross anatomy lab experience took up the bulk of the story, so this one was a refreshing change. Readers are treated to Konner's recollection of remarkable patients he saw on each rotation and the doctors who shaped his education along each step of his path.
Konner's path to medical school was unusual in that he was a well-known anthropologist and college professor when he made the decision, which consequently made him older and wiser than his fellow medical students and most of those above him in the hierarchy. Likewise, his previous life experiences contributed to the areas where he showed the most interest, particularly psychiatry, pediatrics, and general work in the poor community, where social medicine is as important as physical medicine. Other specialties he experiences included surgery, anesthesiology, neurology, general medicine, and OB/Gyn, the last of which he also enjoyed immensely.
While details I'm sure had been changed, and the training occurred before I was born, the book read as if it could have been written any time in recent memory. There were details that placed it in time, such as MRI, in-vitro fertilization, and balloon angiography, all common practices now, being the latest in developing technology, and doctors and patients still smoking in the hospital.
I wouldn't call this book a light read, as Konner's educated status elevated his vocabulary to a high level, and the glossary provided helped with slang terms used in the hospital, but not words he was using in general context. He is the author of other books, and I would be interested in the subject matter, knowing that if it's something outside my area of knowledge, his writing style may be too advanced to make the book flow well enough for me not to fall asleep reading it, an issue I battled while reading his reflections on the 3rd year of training discussed in this book.

[Julie · Rating 4 out of 5]

Very interesting - written by an established anthropologist who's reasons for wanting an education in medicine are admirable; during his fieldwork in third-world countries he frequently sees the suffering and death of natives, especially children, afflicted with illnesses we consider to be minor and easily curable. He seems humane and compassionate, and his stage of life - being 10 to 15 years older than the other med students and with small children at home, along with having been on the teacher side of the table for several years - give him a unique perspective on the medical culture he finds. He is candid, but critical. He finds the schedules to be unnecessarily grueling, most of the doctors to be rude, arrogant and detached, and the whole system to be seriously flawed. This book will not make you want to join their ranks.

[Anjec Naredo · Rating 5 out of 5]

The journey he took is very essential in his conclusion. For every specialization he narrated-- I learned something new but what sets apart is the way he finished the book. A lot of people, well it's actually a cultural conundrum-- the saying that "I want to be a doctor when I grow up" but then again, read the book and then make your own conclusion.

I don't entirely agree with his ending though because I saw myself at times staring at the M.D. tag I drew after my name sometimes for my make believe sessions, but I respect his view on thinking twice in going to that path. It's definitely not for everyone to do.

Thumbs up!

[Mauri · Rating 2 out of 5]

Out of all of the books I have currently read about medical school and residency, this one was by far the most depressing account. For four years, this man details his experience in medical school and its utter lack of redeeming qualities. Bright moments and successes are always overshadowed by diatribes on what is wrong with medical education in this country.

In the end, the author chooses not to continue on into residency, citing multiple reasons as to why he is doing a greater service to public health by NOT becoming a doctor.

A flop.

[Alex Laycock · Rating 3 out of 5]

Cant work out if this book was fascinating,irritating or self centered,or a little scarey,were the chapters too long,each seemed to have the same conclusion,hours are long,mistakes and successes and some senior doctors are very arrogant

[Rae · Rating 3 out of 5]

The author goes to medical school at age 33 and describes in great detail his third year of residency. I enjoyed it but it seemed tedious and a bit depressing by the end.

[Reader · Rating 5 out of 5]

“Becoming a Doctor” is a memoir written by Melvin Konner. This is a compelling memoir that effectively explains the process of his journey becoming a medical expert. He illustrates an image that allows the readers to feel as though they are living his journey by illustrating the sights, sounds, and feelings of the medical training he went through. The book is written in a way that fully grabs the reader’s attention by setting a scene in their head that allows them to feel the authors experiences. Konner’s use of scenery brings the readers into the surgical rooms, clinics, hospitals, patient rooms, allowing them to watch the development firsthand. The language used allows the readers to hear discussions had throughout the training, and different interactions he had with patients, other doctors, and families throughout. The dialogue-heavy approach to the memoir helps the story feel more real while also being able to improve the growth of the characters.

The author’s effective use of self-discovery and self-inquiry is another important trait. Konner shares his personal disputes, doubts, and moments of clarity by sharing his deep thoughts and feelings throughout the process. This reflection gives the memoir a real life feeling and allows the readers to connect with the experiences and the development of the author. This memoir has a wide range of people who read it, because the author encourages the audience to think about their own personal goals and experiences through his own personal observations.

Additionally, “Becoming a Doctor” skillfully includes drama and conflict throughout the story, which keeps the readers engaged by the exciting events. Readers show interest throughout the story because Konner shares the difficulties he encountered throughout the medical study. He includes components like difficult teachers he had, ethical issues encountered, and the emotional toll the patient contacts takes on oneself. The effectively thought-out plot structure leads readers through the highs and lows of his medical journey in a way that is real, motivational, and consistent throughout.

I personally found the memoir “Becoming a Doctor” by Melvin Konner to be an interesting and educational read. The memoir was easily accessible and gave me many moments where I wanted to sit back and think for a moment because of the open narration and perceptive thoughts. A full image of the author’s development was provided through the effective balance between the moments of personal reflection and medical situations. I would recommend this book to others, without a doubt, and especially for anyone interested in any part of a medical field, or even someone just looking for a good insightful read about one’s personal development. In addition to providing insight on the journey to becoming a doctor, Konner also provided insight to larger issues, such as empathy, resiliency, and following a passion, no matter how hard it may get.

[Melissa · Rating 4 out of 5]

When I finished this book I had to wonder why the author went through 4 years of med school, starting at age 33, and never became a doctor. Four years of hard work and lots of money just to study the culture?? Reading this book, especially the end where he speculates on the things that are wrong about medical education and the attempts to change them that he felt were doomed to failure, I wonder how he would see things now. For instance, to remove some of the competitive behavior from the pre-clinical years many med schools no longer give grades during that time. It's pass/fail and at Columbia if you fail a test you go to see the Dean of Students and re-take the exam. Columbia also cut back on some of that enormous knowledge cramming by cutting back on gross anatomy from a whole year to only 1/2 year and pre-clinical there is only 1 1/2 years. The clinical rotations for med students are no longer the same hours as residents- no 36 hour shifts, all-nighters etc. And of course even the resident's hours have been made more reasonable since the Libby Zion case led to a law limiting hours to 80 a week instead of the 100 they used to do. Her death occurred during the time Konner was in med school. The MCAT that is the admissions test for med school is now including psychology/sociology questions to encourage more humanities type pre-med courses. I think the culture has changed somewhat also due to the presence of more women in medicine- they now make up half the students in med schools in the US. This was a total blind spot in Konner's book as there is nothing about sexual harassment in his book which of course he didn't suffer from as a 35 year old white male. This too is much better- the students at Columbia, both male and female, are encouraged to report any harassment by faculty or attendings.

[Matt · Rating 3 out of 5]

I enjoyed reading this author's experiences from his med school journey. I think reading it during med school (which I did) was a most useful time to read it, as I can relate to much of what he discusses. And he got me to think about some of the nuances of medicine that I hadn't considered before.

A few reasons I didn't love it. He is unfortunately quite cynical regarding medical education, which is fine because it isn't a great system, but also perhaps a bit too pessimistic; I think an optimistic view can help eliminate problems that aren't that big of a deal. Also, as others have mentioned in their reviews, he is a bit self-aggrandizing, so just be aware of that.

[Liz Ewans · Rating 4 out of 5]

My daughter recently finished reading this book as she wants to study Medicine. She told me that this book beautifully captures the struggles and triumphs of students navigating the journey through medical school. It offers a raw and honest look into the challenges faced by aspiring doctors, making it a must-read for anyone considering a career in medicine. If you're thinking about pursuing a medical career like the one depicted in the book, I recommend checking out the Canadian medical school consultant services to help guide you through the complex process with ease.

[Colby McArthur · Rating 3 out of 5]

Very interesting read! His discussion of 1980s medical education was eye opening and I enjoyed his comparisons to his anthropological work. It got a bit long at times, but each part did add important context to his ideas. However he was very weird about many female patients and coworkers which was very off-putting and, I feel, unnecessary for the narrative.

[Sue · Rating 4 out of 5]

A collection of doctors write of their training and early work as physicians. Insightful.

[Barbara]

Informative. Detailed. Old

[Sarah Anne · Rating 4 out of 5]

author was a little bit arrogant i think, but the overall the book was very informative and interesting

[Davy Bennett]

Giving to Grandson, who shows an interest.

[Parimala · Rating 4 out of 5]

While it is not easy to draw a parallel between medical education in the US and that in India, this book comes as a breather that one can relate to, particularly because it comes from an anthropologist who chronicled his medical school experience. It is even more useful as an account of someone who entered medical profession even after being well established in his first profession. A peer in this respect.

I took my own sweet time to savor this book. Melvin Konner, through his book, has given me valuable company over the months of reading it. The insights he provides into the various aspects of medical education and medicare are more eloquent because of his unique background.

[Jennifer · Rating 4 out of 5]

This book was a bit outdated, but I imagine it stills gives a fairly accurate view of the medical school experience. It was a very detailed account of example cases with patients and the tough decisions that physicians must make constantly. The author goes into detail about the various areas of medicine that he worked in while going through 3rd year rotations and discussed the major responsibilities and day - to - day work of a doctor in different specialized fields. The tough work and hours were emphasized as well as the lack of humanistic behavior that the author observed from his superiors.

[Taneya · Rating 5 out of 5]

I read this in college. Dr. Konner was an anthropology professor at my school (Emory) and my roommate, who was an anthro major recommended this to me. Excellent read. I loved the stories and it helped keep me motivated to pursue a career in medicine.

[Patrick · Rating 2 out of 5]

A self-reflective book about an anthropologist ethnography of thed medical education system in America.

[John · Rating 4 out of 5]

many of the stories that the author describes as his experience with attending's, etc. are a reminder of the things i do not want to do and the attitude i never want to have.

[Jonathan Sims · Rating 4 out of 5]

It is a very revealing and in depth account of a medical student's initiation into the hallowed ranks of American doctors.

[Keith · Rating 2 out of 5]

Interesting read, but I cannot imagine a more naive person entering medical school. Then again, I can't help but think he might have played that angle just for literary purposes.

[Menolly]

Very similar to other books of this type - wasn't unique enough to bother with

[James Mccullagh · Rating 4 out of 5]

Couldn’t put it down- the other path I did not take?