Monthly Archives: October 2014

Dear medical interns/house officers, it’s time you learned the truth

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This was not written as a self-righteous article to indulge my sense of accomplishment in medical practice. Although I am an internal medicine specialist and a fellow in cardiology, I have achieved nothing if compared to the legends in my field of work. I will not start with the dreaded phrase “During my time…”. I will start by telling you only this… I am going to tell you the truth. At least, the truth the way I see it.

Medicine is difficult if it is seen only as a science.
It is an amalgamation of arts, science and social skills. If you approach your patients with the sole purpose of diagnosing a disease purely on a scientific basis, you will find it difficult.

Textbooks are useless. Patients cannot speak your “language”. They can’t quantify sputum, they forget to notice when their eyes first turned yellow, cannot accurately recall the pattern of their fever and if their stool color has changed over the past week. And that’s what makes them human.

You need to learn the art of history taking and physical examination to coax this out of them. And nurture the ability to treat your patients with respect and dignity they deserve. This cannot be taught in medical school. You will learn this in life. Or rather in the wards.

Internship is physically exhausting
A house officer wrote to a local news daily recently, that he or she is exhausted with internship training. There was an immediate surge of response to this letter. Most of them criticized and condemned the sheer audacity of the author for claiming the training is exhausting when it has been revised so many times to make it better and easier for the young interns to cope.

I will not resile from their position. Nor will I rescind their opinions. After all I am nobody to judge.

In all honesty, training during internship is tough. It drains you in every way possible. But what you fail to remember is the necessity of this training and this ’fleeting moment’ will pass once you complete internship. You are not going to be an intern forever. The ability to function while being sleep deprived is an important attribute for an intern. If you don’t know how, just ask your parents how they managed when you were a toddler. That will set you straight.

Just keep your head down and get on with your work. Only experience, hard work and nerves of steel fostered during your internship years will end up making you a better clinician.

You cannot compare internship training with other countries you have probably studied or worked in briefly. Every system is there for a purpose. To suit the needs of their society and healthcare demands. No system is perfect regardless of the country you work in. They have their flaws and will continue to improve as the demographics of their society changes.

When working hours are reduced, the clinicians complain they cannot pass the necessary skills to the interns and when the hours are increased the interns claim fatigue. This becomes a never-ending vicious cycle of bitter resentment towards each other.

You can choose your preferred area of speciality once you complete your internship training. If you want the working hours of an office clerk, this is the time. No one will fault you for wanting to spend more time with your family. And if you choose to enter a demanding speciality you cannot live under the delusion that you are a better doctor and your work is more worth the while. You define your life with your own rules and don’t impose these rules on others.

I have said this before and I will say it again… Training of doctors should best be left to the practicing clinicians. Keep the politicians and the general public out of this.

Internship is emotionally draining
After a day of being sleep and food deprived, getting your ward in order for the early morning rounds and making sure all the clinical notes are in the correct files, a harsh word from your consultant or superior for a small irrelevant mistake can hurt you deeply. I have felt it before. We all have. It is as if they only focus on your mistakes and not the hard work or effort you have so selflessly given.

I admit it. We sometimes become complacent. We assume it’s interns job to do the work and that you should not ask for a reward or a pat in the back but mistakes should be reprimanded. I apologize. I have been guilty of this too and I pledge to do better.

Do not be afraid of bullies whose only existence is by making the lives of others beneath them miserable, not realizing how pathetic their own lives really are. There are bullies everywhere and not just in medicine. And since bullies only respond to strength, you should be prepared to be much stronger.

And then there are those who push you hard, to become better clinicians and a better person. Their methods may vary but they have your best interest at heart. They are not bullies. And you should have the wisdom and the mental finesse to know the difference.

Do not demand for lesser working hours. Instead demand for better training and teaching. Expose the flaws in the existing system which interferes with your progress as a clinician. Take your superiors to task for not living up to the expected standards. Drag those who hide behind the veils of bureaucracy into the light. Don’t allow the paper pushers and keyboard warriors change the course of your destiny. It is your right to become the best doctor you can possibly be. Don’t let anyone tell you any differently.

There is a beautiful quote by George Bernard Shaw, “ I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”

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The single doctor: What you need to know before marrying one

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I met a patient during her follow up. She was doing well after her coronary stenting and was free from chest pains. She has started gardening and recently enrolled for dancing classes. I was happy for her. Just before leaving the room, she turned and asked the question most single doctors dread… “Are you still single? ”.

I am.

“I have a niece I want you to meet. She is beautiful, intelligent and well mannered. She will take good care of you. She read law in England. We have had quite a few proposals. But I told my brother you are the best person for her. Shall I speak to your parents? Do you have your horoscope with you now?” she blurted out in a single breath.

I have faced this before. And I am always prepared. I told her I was very flattered to be considered but I was too busy working in cardiology that marriage is something for me when I am more settled in life.

“Don’t wait too long. My niece will not remain young forever. And neither will you”.

Indeed. Thank you.

Single doctors are a common breed. Not exotic. But common. We live among you (the rest of the world), and as much as we can, we don’t want to attract attention. But we fail. Miserably.

Let me tell you all that I have heard and witnessed. The good, the bad and the ridiculous.

Doctors make the best spouse because there are caring and sensitive
It’s true the way doctors care for the welfare of others can at times supersede other professions. This law is not inviolate. Caring for another person is an inherent character. It’s also something you need to build and work on. It also depends a lot on how you were raised. You don’t necessarily have to be a doctor to learn to care and be sensitive to the needs of others.
The profession comes with an unavoidable responsibility to care but the onus falls on the doctor to reciprocate in kind. And not all doctors do. There are some who have been numbed by the profession that they don’t care anymore. Death and suffering becomes a routine. So do they now make bad husbands or wives? Obviously not. It just a way they react to the demands of the profession.
And if you want someone to come home in the evening after losing a patient who bled to death on the operating table and ask about how your day was and if the dog has had its bowel movement, you are married to the wrong person.

Marrying a doctor is a ’sound investment’
If based solely on a financial point of view I don’t think this is entirely true. Doctors earn a decent income and unless you are in the private practice, the sum is modest at best. Inflation and lifestyle expenditure within the upper middle class bracket doesn’t help either. Marry an investment banker. Now that’s a real ’good investment’.

Doctors should marry someone who can take care of them
The profession comes with endless responsibilities. And no illness comes with an appointment. For the doctors, the job isn’t ’eight to five’. And having a person to attend to your needs at the end of an exhausting day is a blessing.
But many doctors I know become complacent. They take the sacrifices of their spouses for granted. It is in no part helped by the fact that in certain societies the burden of the household falls solely on the spouse who is married to a doctor because the doctor is assumed to be always busy. Not a very fair deal of you ask me.

Marrying a doctor is a step up the social status ladder
Let me give you a short preview of the not too distant future. Doctors aren’t a rarity like they once were. Due to the incessant mushrooming of medical schools, let me paraphrase AirAsia’s famous slogan… “Now everyone can become a doctor”. So get that silly idea out of your (or your parent’s) head.

Doctors are well bred and well mannered
True. Unless you give us a reason not to be. Just like the rest of the human species we are prone to tantrums, labile emotions and rantings. We become less well mannered and irritable when people try to challenge our years of medical education with snippets they got from the internet last night while smearing night creams on their puffy porcelain faces. Beware. We are not as nice as we are made to seem.

Don’t marry a woman who is a doctor, she will be too busy to take care of you and your children
I came across a saying recently, “When you are dead, you don’t know that you are dead. It is only difficult for the others. It is the same when you are stupid”. That’s sums up what I think of people who make these statements. Some of the best mothers and wives I know happen to be doctors. It’s not about the profession as I have mentioned before. You have to work on being a good mother or a wife regardless of what you do. It comes easier for some who are born with certain innate abilities and for others you need to work just a little bit harder. Doctor or not, you need to learn to live a life balanced between work and home.

I leave with a quote from one of my favorite poets, Rumi, “Don’t be satisfied with stories, how things have gone with others. Unfold your own myth.”

And that is the truth…