Thirtysomething Meets ER

By Lori Gottlieb/Palo Alto

Most students choose a medical school for its prestige or price tag. I chose one where I wouldn't be the only student born before 1970. Two years ago, at 32, I traded in my Hollywood executive's black blazer for blue hospital scrubs at Stanford University in Palo Alto, Calif. Thirty-two may seem young, but in medical education, which can last more than a decade, it's often considered over the hill.

That attitude is changing. Last year for the first time, U.S. med-school applicants ages 24 and older outnumbered those who applied at the traditional ages of 21 to 23. The older students aren't just kids who take a year or two off after college; a growing number are folks like me who pursued another career before deciding to become a doctor. My classmates are as old as 46 and include a former actress, a bond trader, an engineer, a lawyer, the manager of an auto-parts store, a single mom and a tax expert for the U.S. Treasury. Stanford's med school welcomed us because it--along with Northwestern, Yale and the University of California, San Francisco, among others--believes real-world experience helps make better doctors.

Yet even at Stanford a divide existed between Us--peppered among the student body like beneficiaries of some geezer affirmative-action program--and Them--22-year-old biochemistry majors. At orientation, one young classmate told me, "Wow, by the time you start practicing, you'll be almost menopausal!"

After that, I made an effort to assimilate. I traded dresses with a 23-year-old before the school's formal dance. I wrote our anatomy group's freshman skit. I kept up with the who's-dating-whom gossip. I even went to a few keg parties. Still, we career switchers didn't quite fit in. We had outgrown our college-age antics. Instead of joining our younger classmates for late-Thursday bar nights, we opted for a sedate viewing of ER before bed. We replaced their mantra, "Highest score rocks," with our own: "Lowest pass wins." We worked hard but opted for some balance in our lives.

Great for us, but what about our future patients? As part of our final exam in the "Patient-Doctor" course, each student took down a patient's medical history. My professor observed that I was the only student in her group who first bothered to introduce myself to the patient. I was also the only second-career student.

Coincidence? She didn't think so. One younger student, she said, had dutifully memorized the 10 "nonverbal communication skills" from our handout (vary your gaze, lean toward the patient, nod frequently, use hand gestures) and performed them all in rote sequence, prompting her concerned patient to ask, "Are you O.K., honey?" Another younger student, in a rush to get his patient's sexual history, asked her bluntly, "Do you have sex with men, women or both?" The grandmother of three, recovering from a heart condition, stared back dumbfounded.

As my professor noted, "It's much harder to teach social skills than science."

--By Lori Gottlieb/Palo Alto