A Referendum on the Self: On Entering the Medical Profession

A student once told me a story about a letter of recommendation he received that portrayed him as a restless contrarian philomath. The student asked the letter writer, “Don’t you think this letter will turn off some programs?” The writer responded, “Would you want to train at those programs?”

I thought about this story while reading Pradyumna Sapre’s essay. I have written about how I worry that our application process leads us to miss some promising students. I am glad Mr. Sapre has found a home, and I look forward to following his trajectory.

Adam Cifu

In the first draft of my medical school personal statement, I referred to Kazimir Malevich —my favourite Russian modernist painter’s—formalist compositions, Tolstoyan wisdom about tending to the dying in Anna Karenina, a story about humming Dvorak’s Ninth Symphony at a patient’s bedside, and how the Bergsonian notion of consciousness and time might be relevant in neurology.

One of my best friends from college was my first reader. He was unsurprised by the essay. He told me to cut “some of the more arcane humanities references” in the gentlest possible way, aware that he was killing my darlings. I begrudgingly culled Bergson and Malevich, though I couldn’t bear to sacrifice Tolstoy and Dvorak. To compensate for the loss, I crafted my personal statement around how the humanities call me to medicine—how the humanities have enabled me to connect most with patients in moments of great vulnerability.

When I showed it to a less biased reviewer, he said, “What is this? You should write about basic science instead.” I ignored him, added a sentence about what the aesthetic self-consciousness of Realist art teaches us about intellectual humility in medicine, and sent in the essay.

***

I entered college in 2020, aspiring to be a physician but with an enduring love of the humanities. I knew early on that I didn’t want to fit the typical pre-med archetype: perennially stressed and always complaining about an upcoming orgo exam.

Early on, I invested in the humanities and in a diverse range of experiences. I spent more time writing opinion columns than on EMS shifts. I joined a sketch comedy group. When the sight of micropipettes began to make me feel nauseous, I “quiet quit” my wet lab. I loved volunteering every week at Yale New-Haven Hospital, chronicling the stories of patients I met there and uploading them to their charts, but I took on an informal leadership role instead of running for President of the club.

Buoyed by the adulation of well-wishers and a loose philosophical conviction whose origin I can’t place, that “well-rounded people make good doctors,” I placated my own concerns about whether I was doing enough to prepare for application season. I vowed to tick the necessary premed boxes but to focus more on developing an identity outside of medicine.

I viewed pre-med culture as antithetical to the liberal arts model, where college years offer a broad intellectual, social, and cultural education that expands the mind and heart and lasts far beyond college’s cloisters. Focusing disproportionately on basic science research I didn’t enjoy, accruing titular positions in the name of padding my CV, chasing additional service experiences in pursuit of a 15^th AMCAS activity felt like spending four years at an intellectual carnival on a single, rickety ride, without even chit-chatting with my co-riders.

And yet, in the months after I graduated, as I began to stare down the barrel of impending applications, I was gripped by anxiety around whether I had done enough. By working in a lab for two years instead of four, or by refusing to dedicate my gap year to more typical clinical experiences, was I avoiding unnecessary “weed out” tasks or just dressing hedonism—a prioritization of things I enjoyed doing—in the extravagant, inflated costumes of a “liberal arts education”?

I spent my gap year more smoothly balancing these dual identities with greater ease: the dedicated future doctor who volunteered at a hospice facility every weekend, with the sensualist who spent Tuesday evenings basking on a picnic blanket and reading Elena Ferrante in Central Park.

When I eventually applied to medical school, I did so with top grades, scores, and pedigree, and yet I worried my extracurricular profile was more “interesting” than “impressive”—from a purely “premed” lens. My conviction to be a physician had never wavered, and I hoped that my clear love of the humanities and my investment in community would only help contextualize my clinical experiences. Wouldn’t you want a doctor who was also a good friend to the people in his life?

My future success in the medical school application process began to feel like a referendum on my decision-making. Faced with skeptical mock interviewers who told me that most doctors believe the humanities are a mere luxury, stories of medical students who published scores of articles on diabetes management before their first year of medical school, and the general sense that there was nothing special about me from a cynic’s standpoint, I began to feel like an imposter to my own convictions.

A lack of success would be incontrovertible evidence that the notion “interesting people make interesting applicants,” which I had blithely parroted to myself, was fraudulent.

If I could go back in time, I would do many things differently. I’d have started publishing health policy research—as I did in my senior year—earlier in my college career. I’d probably have sought out service experiences that better fit my personal identity. I would have played the game more.

I don’t believe that the ability to enjoy wet lab research is a prerequisite for future success as a physician. Nor do I doubt the thrust behind the idea that people who’ve spent more time honing soft skills or gaining interdisciplinary knowledge might be better able to relate to patients. But I wish I had saved myself the heartache of knowing I did less than I could have to optimize my application for success.

On the other side of the process, as I look forward to matriculating to medical school, I’m filled with nothing but excitement. I can’t wait to spend my days thinking about physiology and pathology; I can’t wait to feel like everything I am studying could tangibly change a life. I already read Sensible Medicine in my free time; I’m excited to understand more of it.

I’m grateful to have interviewed at many excellent schools and committed to a program where both my interviewers told me to dream big, that their school is the perfect place for future physicians with interests beyond the canonical triad of clinical work, research, and education: for physician-innovators, physician-writers, and physician-humanists.

Sometimes, I still think about the programs I didn’t interview at. The admissions officers who tossed my application on the no pile because I had more research hours in Russian art history than in RNA biology. The interviewers who thought that my humanistic understanding of medicine was “precious” or that my love of the humanities was “pretentious.” In rare moments, it is still a hard pill to swallow. It remains easy to caricature myself as a lazy sybarite, not having made the most of every pre-med opportunity to optimize for the selection criteria of my future career, opting instead for things that fulfilled me.

And then I remind myself, even if I had made every traditional choice or done one more interview, I’m not sure I would have thrived at a traditional program that doesn’t encourage a diversity of interests—within and beyond medicine. I’m excited to nerd out over heart murmurs, septic shock prevention, and the art of diagnosis with new friends in medical school. But I’m also excited to share my reflections from attending the Ben Shahn exhibit at the Jewish Museum with them, as well as with the art historian whom I care for during my clinical clerkship.

I could have been a much better pre-med. But I don’t think it would have made me a better doctor.

Pradyumna (Pradz) Sapre is an incoming medical student at Weill Cornell Medical College in New York City. He is a recent graduate of Yale University with a B.S. in molecular biochemistry and a BA in the humanities, focusing on Russian literature and art history. He wrote a regular opinion column of personal essays and anthropological observations while in college, a practice he hopes to continue throughout his medical career.