SGEM Xtra: Ten Lessons They Don’t Teach in Medical School (But Should)

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Date: May 14, 2025

Dr. Ross Prager

Guest Skeptic: Dr. Ross Prager is an Intensivist at the London Health Sciences Centre and an adjunct professor at Western University. His expertise in critical care medicine is complemented by his research interests in critical care ultrasound and evidence-based knowledge translation.

This is an SGEM Xtra episode. The inspiration was a thread Ross posted on X: Here are 10 lessons they don’t teach in medical school (but should) that I’ve learned the hard way over the years. He shared ten hard-earned lessons from his clinical life that never made it into the standard curriculum. These lessons are rooted in humility, human connection, and the everyday realities of medical practice.

1. Patients Don’t Care How Much You Know, but How You Make Them Feel

Sit down with your patients — standing can seem rushed.
Recognize emotions: “I imagine this must be stressful.”
Be human. It’s OK to say “I don’t know” or admit fallibility. Patients value authenticity over perfection.

2. You’re Remembered by Your Worst Moments

When stress hits, your true self emerges — that is what people remember.
Grace under pressure matters more than glory during routine.

3. Stop Trying to Impress People with Knowledge

Competence is shown, not shouted.
The best clinicians are present and kind, not performative.

4. Being Keen Is Not a Crime

Passion is a virtue, not a vice.
Don’t hide your enthusiasm. It’s a sign you care.

5. Med School and Residency Are Long Job Interviews

Every rotation, every shift, every colleague — it all counts.
Build your reputation day-by-day with kindness, work ethic, and humility.

6. Absence of Evidence ≠ Evidence of Absence

Not everything is backed by RCTs — that doesn’t mean it’s invalid.
Clinical observation and physiologic rationale matter (e.g., vasopressors).
As always, be skeptical of the lack of evidence, too.

7. Character Is How You Treat People Who Don’t Supervise You

It’s easy to be kind to your boss.
Your true self shows in how you treat nurses, janitors, and trainees.

8. Focus on Diagnosis First, Treatment Second

Most medical harm arises from misdiagnosis, not mismanagement.
Think ten times harder about “what’s going on” before “what should we do?”

9. Don’t Postpone Living Until After Residency

If you’re waiting for life to get better after training, you’re doing it wrong.
Find joy now. Build habits of balance early — your future self will thank you.

10. Remember the Spark

Recall your first patient: the awe, the uncertainty, the honour.
When burnout creeps in, revisit that moment. Reconnect with your “why.”

Final Thought from Dr. Prager: “Medicine is not just about answers, it’s about presence. Our best tool is our humanity.”

The SGEM will be back next episode with a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window from over ten years to less than one with the power of social media.