"You're smart, but you lack common sense." What a doctor who graduated from the University of Tokyo Faculty of Medicine realized after 17 years

It was during my first year as a resident. A veteran nurse said it to me casually in the hospital corridor.

"Doctor, you're smart, but you lack common sense."

I don't think she meant any harm. But that one remark changed my life as a doctor.

This article is a record of what I realized over 17 years—after graduating from the University of Tokyo Faculty of Medicine, earning my specialist certification and a PhD, and publishing papers in Nature-affiliated journals, yet still being a "useless doctor" in clinical practice.

I hope this reaches anyone, not just doctors, who has ever felt that they "can study well but can't apply it in the field."

1. 115 points on the University of Tokyo math exam. But I was a "useless doctor" in clinical practice

Medical school entrance exams are, at their core, a game of memorization and processing speed.

Even for the University of Tokyo's math exam, the essence is nothing more than pattern recognition. You memorize fixed solution patterns and, the moment you see a problem, you apply the thought, "This is that type." I scored 115 out of 120 on the actual exam, but I didn't solve a single problem through a flash of insight. Everything was a reproduction of patterns I had prepared in advance.

I passed the national medical licensing exam, too. I even published a paper as the first author in a Nature-affiliated journal. But the moment I stood in the clinical setting as a resident, I realized I was a "useless doctor."

The patients in front of me didn't present symptoms exactly like the textbooks. Test results didn't come back immediately. And if I made a wrong judgment, people would die.

I tried desperately to arm myself with textbook knowledge. I memorized guidelines, hammered a list of differential diagnoses into my head, and tried to compete based on the sheer volume of knowledge. What was the result?

I ended up being a doctor who had knowledge but couldn't act in the field.

2. The night I believed "I'm fine," and the nurse call rang

When I was a resident, I asked a post-operative patient, "How is the pain?" They replied with a smile, "I'm fine." I wrote "No pain" in the medical chart.

In the middle of the night, the nurse call rang. The patient was unable to move due to severe pain.

Later, a nurse told me, "Didn't you know that person is the type to endure pain in front of a doctor?"

I didn't know.

A patient saying "I'm fine" often means they are not fine. Reading their facial expressions, tone of voice, and body movements rather than just their words—that obvious skill was something I lacked.

It can't be measured by deviation scores. It's not written in textbooks. But in clinical practice, whether or not you can do this changes a patient's fate. The sound of that nurse call that night still rings in my ears.

3. The day the head nurse scolded me, "You do it yourself!"

A doctor cannot save a patient alone.

Nurses, pharmacists, physical therapists, radiological technologists, and social workers. Healthcare operates as a team. This is obvious, but as a resident, I didn't understand it.

I once instructed the nurse in charge of a pneumonia patient with a lot of phlegm to perform suctioning every 20 minutes. I just gave the order and left. I didn't even consider how many other patients that nurse was responsible for.

Later, I was called in by the head nurse and told one thing.

“Why don't you do it yourself!”

I had no words to reply.

I found pharmacists' inquiries troublesome. I dumped the goal-setting for rehabilitation onto the physical therapists. Looking back now, it's embarrassing, but I unconsciously thought that "doctors are the most important."

Doctors who are trusted in clinical practice have respect for paramedical staff. This isn't about kindness; it's a rational judgment to maximize the team's overall strength. "Why don't you do it yourself!" was the remark that fundamentally changed how I worked from then on.

4. The story of a senior doctor who embodied everything

While repeating failures, I met one senior doctor.

That doctor was also a former member of the Japanese national lacrosse team. By the way, as you might imagine, he was an orthopedic surgeon. He would make rounds on the ward alone at 5:30 AM and head off to lacrosse practice after finishing his rounds.

Whenever someone called out to him, he would always turn his body and gaze toward them. He would always raise the corners of his mouth slightly to create a smile. He did this without exception, whether for nurses, residents, or cleaning staff.

That doctor would always pick up trash if he saw it on the hospital corridor floor. One day, when I saw that and said, "That's amazing," he replied like this.

“If you have to think about it before picking it up, it's no good.”

This remark has remained deeply with me. What I lacked wasn't knowledge, but "innate intelligence." The innate intelligence I'm talking about here isn't about IQ.

The ability to read between the lines of a patient's situation.
The ability to work from the same perspective as paramedical staff.
And whether your body moves before you think.

Knowledge can be produced after thinking. But consideration is too late once you've thought about it. That doctor's 5:30 AM rounds, his smile, and his act of picking up trash were all the actions of a person who "moves before thinking."

I haven't reached that level yet. But because I saw that example, I think I've been able to keep heading in the right direction without going astray.

5. The reason why panicked patients leave after hearing the words, "That must have been tough"

As the years have passed, there are things I've come to understand a little better.

A panicked patient comes to the emergency room in the middle of the night. Tests show nothing abnormal. Even after listing differential diagnoses and explaining, "You're going to be fine," they absolutely refuse to go home. If I were still a resident, I would have panicked at this point. I would have tried to explain the test results more carefully or tried to order additional tests.

But now, I do something different. I crouch down to be at the same eye level as the patient.
I gently place a hand on their shoulder and say in a slow, calm voice.

"That must have been so hard for you."

With just that, they feel reassured and go home.

Medically, nothing has been solved. But I think what that person was looking for wasn't a correct diagnosis, but the feeling of being understood. This wasn't written in any textbook.

That night, the resident version of me, who took "You're going to be fine" at face value, could never have done that. What changed wasn't my knowledge. I just became able to imagine, even a little, what lies behind a patient's words. That's all.

6. Becoming a doctor through test scores, and becoming a doctor again in the field

You can become a doctor through academic background. This is a fact. If your test scores are high, you can get into medical school. If you pass the exam, you get a medical license. Systemically, that is all it takes to become a "doctor."

But academic background alone doesn't make you a good doctor. It took me 17 years to finally be convinced of this.

The reason patients trust me now is not because I graduated from the University of Tokyo Faculty of Medicine. It's because when I was a resident, I was told I "lacked common sense," I misread a patient's "I'm fine," I was scolded by the head nurse who said, "You do it!," and I watched the backs of senior doctors and realized how small I was.

It's because I learned from each and every one of those experiences.

Become a doctor through test scores, and become a doctor again in the field.

If that nurse hadn't said, "You're smart, but you lack common sense" that day, I would probably still be a "useless doctor." I am grateful to her.

If there is anyone else who feels like they "have knowledge but can't apply it in the field," I hope this article provides even a small hint. The power that cannot be measured by test scores can only be acquired in the field.

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For those who want to know more (Related articles)

These are two articles written from different angles about this story of "becoming a doctor again while being embarrassed in the field."

▼ Why is attentiveness not rewarded?
The best doctor is thanked by no one | A 2,300-year-old anecdote predicted preventive medicine(Free)
The more you prevent things by acting in advance, the less noticeable the results become. I wrote about the true nature of that lack of reward based on a 2,300-year-old anecdote. This story connects to "what is a good doctor" in this article.

▼ What did I spend my time on that paid off later?
The top 10 self-investments with the highest returns, realized by a doctor who graduated from the University of Tokyo Faculty of Medicine over 17 years(Free)
After 17 years, it became clear which investments had high returns and which were a complete waste. This is a version that expands the "humble accumulation" mentioned in this article to my entire career.

Announcement of the membership "Dr. Mosari Lab"
I run a membership called "Dr. Mosari Lab." I write about things that go a step further, which I cannot share on X or in free notes.

• The content I actually discuss in outpatient visits as a primary care physician for business executives

• Records of what worked and what didn't, tested on my own body while reading research papers

• How to read lab results and how to choose supplements and medications

• Members-only Q&A bulletin board

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