Things that I didn't know about medicine before I started

• How many people in hospital are there, not because they are in actual need of the services hospitals provide, but because the provision for them in society is so inadequate. This mostly includes elderly people with nowhere to go that will care for them. These patients are often turfed to hospital from the bad nursing homes.
• How bad some nursing homes can be. Also, just as much, how good some nursing homes can be.
• How hard nurses work, for so little respect and appreciation. And how good nursing care is as important, maybe more so, than good doctors.
• How many patients are not listened to by their doctors. It seems so basic to me. I think it was William Osler who said "Listen to your patients. They are giving you the diagnosis".
• How little explanation patients get from their doctors and other health professionals. I remember one clinic with a vascular surgeon, with a middle aged man who came in because of claudication (where you get pain in the legs when you exercise, becuase the blood flow isn't sufficient.) He said, at a very fast pace. "Yeah, you've got quite significant claudication. Probably atherosclerosis. I'll send you for a doppler. When we get the results you might need an angioplasty for that." Patient: "Sorry, what?" Doctor: "Angioplasty." Slower and clearer as if he didn't hear. Patient, seeing the doctor was pissed off : "How do you spell it? I'll look it up." The patient looked at me. I looked at the doctor, becuase I didn't want to piss him off. He shrugged and went to do paperwork at his desk before the next patient. I took the opportunity to tell the patient quickly about what the words meant. I would hate to become santimonious, but really, I hope I never forget that not everyone has been to medical school, and that it doesn't make people stupid to not know what all the terms I have spent six years trying to cram into my head.
• Just how much your lifestyle and money and education affect your health, not advanced medicine. I don't mean in this country - around the world.
• How little resources and time are given to palliative care in this country. It's shockingly underfunded. So many doctors I speak to don't even see the importance of the whole speciality. Doing Oncology a few months ago, I spent time in the hospice next to the hospital. Funded charitably. Staffed by volunteers.
• How rare it is for even the best doctors to do more than delay death a short time. In many ways it's a losing battle.
• The only lifelike character on Scrubs is Dr Kelso.
• How much influence big pharma has on research, attitudes, and prescribing habits, how sneaky and underhanded the propaganda can be, and how this is accepted by most.
• How brave most people are in the face of losing their health.